# Two Correlated Proportions (McNemar Test)

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1 Chapter 50 Two Correlated Proportions (Mcemar Test) Introduction This procedure computes confidence intervals and hypothesis tests for the comparison of the marginal frequencies of two factors (each with two levels) based on a -by- table of n pairs. Confidence limits can be obtained for the marginal probability difference, ratio, or odds ratio. Inequality tests are available for the marginal probability difference and ratio. Experimental Design A typical design for this scenario involves pairs of individuals where a dichotomous measurement of one factor is measured on one of the individuals of the pair (case), and a second dichotomous measurement based on a second factor is measured on the second individual of the pair (control). Or similarly individuals are measured twice, once for each of two dichotomous factors. Comparing Two Correlated Proportions Suppose you have two dichotomous measurements Y and Y on each of subjects (where in many cases the subject may be a pair of matched individuals). The proportions P and P represent the success probabilities. That is, ( ) ( ) P Pr Y P Pr Y The data from this design can be summarized in the following -by- table: Y (Yes, Present) Y 0 (o, Absent) Total Y (Yes, Present) A B A + B Y 0 (o, Absent) C D C + D Total A + C B + D 50-

2 The marginal proportions P and P are estimated from these data using the formulae A + B p and p Three quantities which allow these proportions to be compared are A + C Quantity otation Difference P P Risk Ratio φ P / P Odds Ratio ψ O O Although these three parameters are (non-linear) functions of each other, the choice of which is to be used should not be taken lightly. The associated tests and confidence intervals of each of these parameters can vary widely in power and coverage probability. Difference The proportion (risk) difference δ P P is perhaps the most direct method of comparison between the two event probabilities. This parameter is easy to interpret and communicate. It gives the absolute impact of the treatment. However, there are subtle difficulties that can arise with its interpretation. One interpretation difficulty occurs when the event of interest is rare. If a difference of 0.00 were reported for an event with a baseline probability of 0.40, we would probably dismiss this as being of little importance. That is, there usually is little interest in a treatment that decreases the probability from to However, if the baseline probably of a disease was 0.00 and 0.00 was the decrease in the disease probability, this would represent a reduction of 50%. Thus we see that interpretation depends on the baseline probability of the event. A similar situation occurs when the amount of possible difference is considered. Consider two events, one with a baseline event rate of 0.40 and the other with a rate of 0.0. What is the maximum decrease that can occur? Obviously, the first event rate can be decreased by an absolute amount of 0.40 while the second can only be decreased by a maximum of 0.0. So, although creating the simple difference is a useful method of comparison, care must be taken that it fits the situation. Ratio The proportion (risk) ratio φ p / p gives the relative change in risk in a treatment group (group ) compared to a control group (group ). This parameter is also direct and easy to interpret. To compare this with the difference, consider a treatment that reduces the risk of disease from to Which single number is most enlightening, the fact that the absolute risk of disease has been decreased by , or the fact that risk of disease in the treatment group is only 55.8% of that in the control group? In many cases, the percentage (00 x risk ratio) communicates the impact of the treatment better than the absolute change. Perhaps the biggest drawback of this parameter is that it cannot be calculated in one of the most common experimental designs: the case-control study. Another drawback, when compared to the odds ratio, is that the odds ratio occurs naturally in the likelihood equations and as a parameter in logistic regression, while the proportion ratio does not. 50-

3 Odds Ratio Chances are usually communicated as long-term proportions or probabilities. In betting, chances are often given as odds. For example, the odds of a horse winning a race might be set at 0-to- or 3-to-. How do you translate from odds to probability? An odds of 3-to- means that the event will occur three out of five times. That is, an odds of 3-to- (.5) translates to a probability of winning of The odds of an event are calculated by dividing the event risk by the non-event risk. Thus, in our case of two populations, the odds are O P and P O P P For example, if P is 0.60, the odds are 0.60/ In some cases, rather than representing the odds as a decimal amount, it is re-scaled into whole numbers. Thus, instead of saying the odds are.5-to-, we may equivalently say they are 3-to-. In this context, the comparison of proportions may be done by comparing the odds through the ratio of the odds. The odds ratio of two events is ψ O O P P P P In the case of two correlated proportions, the odds ratio is calculated as ψ Until one is accustomed to working with odds, the odds ratio is usually more difficult to interpret than the proportion (risk) ratio, but it is still the parameter of choice for many researchers. Reasons for this include the fact that the odds ratio can be accurately estimated from case-control studies, while the risk ratio cannot. Also, the odds ratio is the basis of logistic regression (used to study the influence of risk factors). Furthermore, the odds ratio is the natural parameter in the conditional likelihood of the two-group, binomial-response design. Finally, when the baseline event-rates are rare, the odds ratio provides a close approximation to the risk ratio since, in this case, P P, so that B C P P P ψ φ P P P One benefit of the log of the odds ratio is its desirable statistical properties, such as its continuous range from negative infinity to positive infinity. Confidence Intervals Several methods for computing confidence intervals for proportion difference, proportion ratio, and odds ratio have been proposed. We now show the methods that are available in CSS. 50-3

4 Difference Four methods are available for computing a confidence interval of the difference between the two proportions P. The lower (L) and upper (U) limits of these intervals are computed as follows. ote that z z α / is P the appropriate percentile from the standard normal distribution. ewcombe (998) conducted a comparative evaluation of ten confidence interval methods. He recommended that the modified Wilson score method be used instead of the Pearson Chi-square or the Yate s Corrected Chi-square. am s Score For details, see am (997) or Tango (998). The lower limit is the solution of and the upper limit is the solution of where σ 0 is given by σ p + p n e e 8 f p + 4 p p ( ) ( p ) e + f ( ) + p L inf : 0 0 < z σ 0 U sup : 0 0 > z σ 0 Wilson s Score as modified by ewcombe For further details, see ewcombe (998c), page 639. This is ewcombe s method 0. L δ where δ f φf g + g 3 3 U + ε ε g φg f + f f ( A + B) l

5 g f g u ( A + C) ( A + B) 3 l 3 3 u 3 ( A + C) and l and u are the roots of A + B x z x ( x) and l 3 and u 3 are the roots of A + C x z x ( x) φ ˆ φ max( AD - BC - /,0) ( A + B)( C + D)( A + C)( B + D) AD - BC ( A + B)( C + D)( A + C)( B + D) if AD > BC otherwise ote that if the denominator of φ is zero, φ is set to zero. Wald Z Method For further details, see ewcombe (998c), page 638 L zs W where ˆ p ( B C) ( A + D)( B + C) p / s W BC U + zs W Wald Z Method with Continuity Correction For details, see ewcombe (998c), page 638. L ˆ zs W U ˆ + zsw

6 Ratio Two methods are available for computing a confidence interval of the risk ratioφ P / P. ote that z z is α / the appropriate percentile from the standard normal distribution. am and Blackwelder (00) present two methods for computing confidence intervals for the risk ratio. These are presented here. ote that the score method is recommended. Score (am and Blackwelder) For details, see am and Blackwelder (00), page 69. The lower limit is the solution of and the upper limit is the solution of where z ( φ ) ( p p ) ( p + p ) φ φ z z ( φ) ( φ) z α / z / α and ( p + p ) + ( p φp ) φ ( φ + ) p + φ + 4φ p p p ( )( ) p p φ p φ Wald Z (am and Blackwelder) For details, see am and Blackwelder (00), page 69. The lower limit is the solution of and the upper limit is the solution of where ( pˆ pˆ ) ( pˆ pˆ ) φ z W ( φ ) φ + z z ( ) z / W φ α ( ) z / W φ α Odds Ratio Sahai and Khurshid (995) present two methods for computing confidence intervals of the odds ratio ψ O / O. ote that the maximum likelihood estimate of this is given by ψ ˆ B / C 50-6

7 Exact Binomial The lower limit is and the upper limit where F is the ordinate of the F distribution. ψ L ψ U B ( C + ) Fα /,C+,B B + CF α /,B+,C Maximum Likelihood The lower limit is and the upper limit where { ( ) } ψ L exp ln ψ zα / sψ { ( ) } ψ U exp ln ψ + zα / sψ s B ψ ˆ + C Hypothesis Tests Difference This module tests three statistical hypotheses about the difference in the two proportions: H a. H 0 : P P versus : P P ; this is a two-tailed test.. H 0 L : P P versus : P P < ; this is a one-tailed test. H al 3. H 0 U : P P versus H : P P > au ; this is a one-tailed test. am Test Liu et al. (00) recommend a likelihood score test which was originally proposed by am (997). The tests are calculated as where σ σ L U σ σ z L + and z U σ σ L U 50-7

8 and p + p D σ D e e 8 f p + 4 p p D ( D) ( p D) e ˆ + f D + ( D) p Mcemar Test Fleiss (98) presents a test that is attributed to Mcemar for testing the two-tailed null hypothesis. This is calculated as χ ( B C) B + C Mcemar Test with Continuity Correction Fleiss (98) also presents a continuity-corrected version of Mcemar test. This is calculated as χ ( B C ) B + C Wald Test Liu et al. (00) present a pair of large-sample, Wald-type z tests for testing the two one-tailed hypothesis about the difference p p. These are calculated as where ˆ σ ˆ p p p + p ˆ z L ˆ + and σˆ z U ˆ + σˆ Ratio This module tests three statistical hypotheses about the difference in the two proportions:. H : P P φ versus : P P φ ; this is a two-tailed test. 0 / H a /. H L : P P φ versus : P P > φ ; this is a one-tailed test. 0 / H al 3. H U : P P φ versus : P P < φ ; this is a one-tailed test. 0 / H au / / 50-8

9 am Test For details, see am and Blackwelder (00), page 69. The test statistic for testing a specific value of φ is where z ( φ ) ( p + p ) + ( p φp ) φ ( φ + ) ( p p ) ( p + p ) φ φ p + φ + 4φ p p p ( )( ) p p φ p φ Data Structure This procedure can summarize data from a database or summarized count values can be entered directly into the procedure panel. Procedure Options This section describes the options available in this procedure. Data Tab The data values can be entered directly on the panel as count totals or tabulated from columns of a database. Type of Data Input Choose from among two possible ways of entering the data. Enter Table of Counts For this selection, each of the four response counts is entered directly. Var Var Yes o Yes o The labels Yes and o are used here. Alternatives might instead be Success and Failure, Presence and Absense, Positive and egative, Disease and o Disease, or 0, or something else, depending on the scenario. Tabulate Counts from the Database Use this option when you have raw data that must be tabulated. You will be asked to select two columns on the database, one containing the values of variable (such as and 0 or Yes and o) and a second variable containing the values of variable (such as and 0 or Yes and o). The data in these columns will be read and summarized. 50-9

10 Headings and Labels (Used for Summary Tables) Heading Enter headings for variable and variable. These headings will be used on the reports. They should be kept short so the report can be formatted correctly. Labels Enter labels for the first and second variables. Since these are often paired variables, the labels will often be the same for both variables. Counts (Enter the Individual Cells) Counts Enter the counts in each of the four cells of the -by- table. Since these are counts, they must be a non-negative numbers. Usually, they will be integers, but this is not required. Database Input Variable Specify one or more categorical variables used to define variable. If more than one variable is specified, a separate analysis is performed for each. This procedure analyzes two values at a time. If a variable contains more than two unique values, a separate analysis is created for each pair of values. Sorting The values in each variable are sorted alpha-numerically. The first value after sorting becomes value one and the next value becomes value two. If you want the values to be analyzed in a different order, specify a custom Value Order for the column using the Column Info Table on the Data Window. Variable Specify one or more categorical variables used to define variable. If more than one variable is specified, a separate analysis is performed for each. This procedure analyzes two values at a time. If a variable contains more than two unique values, a separate analysis is created for each pair of values. Sorting The values in each variable are sorted alpha-numerically. The first value after sorting becomes value one and the next value becomes value two. If you want the values to be analyzed in a different order, specify a custom Value Order for the column using the Column Info Table on the Data Window. Frequency Variable Specify an optional column containing the number of observations (cases) represented by each row. If this option is left blank, each row of the dataset is assumed to represent one observation. Break Variables Enter up to five categorical break variables. The values in these variables are used to break the output up into separate reports and plots. A separate set of reports is generated for each unique value (or unique combination of values if multiple break variables are specified). 50-0

12 Ratio Reports Tab Confidence Intervals of the Ratio (P/P) Use these check boxes to specify which confidence intervals are desired. Inequality Tests of the Ratio (P/P) Use these check boxes to specify which tests are desired. Test Direction Use these drop-downs to specify the direction of the test. Odds Ratio Reports Tab Confidence Intervals of the Odds Ratio (O/O) Use these check boxes to specify which confidence intervals are desired. Report Options Tab This tab is used to specify the hypothesis test alpha, the data reports, and the report decimal places. Report Options These options only apply when the Type of Data Input option on the Data tab is set to Tabulate Counts from the Database. Variable ames This option lets you select whether to display only variable names, variable labels, or both. Value Labels This option lets you select whether to display data values, value labels, or both. Use this option if you want the output to automatically attach labels to the values (like Yes, o, etc.). See the section on specifying Value Labels elsewhere in this manual. Report Decimal Places Alpha Percentages These options specify the number of decimal places to be displayed when the data of that type is displayed on the output. This is the number of digits to the right of the decimal place to display for each type of value. If one of the Auto options is used, the ending zero digits are not shown. For example, if Auto (Up to 7) is chosen, is displayed as 0.05 and is displayed as The output formatting system is not designed to accommodate Auto (Up to 3), and if chosen, this will likely lead to lines that run on to a second line. This option is included, however, for the rare case when a very large number of decimals is desired. Table Formatting These options only apply when Individual Tables or Combined Tables are selected on the Summary Reports tab. 50-

13 Column Justification Specify whether data columns in the contingency tables will be left or right justified. Column Widths Specify how the widths of columns in the contingency tables will be determined. The options are Autosize to Minimum Widths Each data column is individually resized to the smallest width required to display the data in the column. This usually results in columns with different widths. This option produces the most compact table possible, displaying the most data per page. Autosize to Equal Minimum Width The smallest width of each data column is calculated and then all columns are resized to the width of the widest column. This results in the most compact table possible where all data columns have the same width. This is the default setting. Custom (User-Specified) Specify the widths (in inches) of the columns directly instead of having the software calculate them for you. Custom Widths (Single Value or List) Enter one or more values for the widths (in inches) of columns in the contingency tables. This option is only displayed if Column Widths is set to Custom (User-Specified). Single Value If you enter a single value, that value will be used as the width for all data columns in the table. List of Values Enter a list of values separated by spaces corresponding to the widths of each column. The first value is used for the width of the first data column, the second for the width of the second data column, and so forth. Extra values will be ignored. If you enter fewer values than the number of columns, the last value in your list will be used for the remaining columns. Type the word Autosize for any column to cause the program to calculate it's width for you. For example, enter Autosize 0.7 to make column be inch wide, column be sized by the program, and column 3 be 0.7 inches wide. Plots Tab The options on this panel allow you to select and control the appearance of the plots output by this procedure. Select and Format Plots To display a plot for a table statistic, check the corresponding checkbox. The plots to choose from are: Total Counts Total Proportions Click the appropriate plot format button to change the corresponding plot display settings. Show Break as Title Specify whether to display the values of the break variables as the second title line on the plots. 50-3

14 Example Analysis of Two Correlated Proportions This section presents an example of how to run an analysis on hypothetical data. In this example, two dichotomous variables where measured on each of fifty subjects; 30 subjects scored yes on both variables, 9 subjects scored no on both variables, 6 scored a yes and then a no, and 5 scored a no and then a yes. You may follow along here by making the appropriate entries or load the completed template Example by clicking on Open Example Template from the File menu of the window. Open the window. Using the Analysis menu or the Procedure avigator, find and select the Two Correlated Proportions (Mcemar Test) procedure. On the menus, select File, then ew Template. This will fill the procedure with the default template. Specify the Data. Select the Data tab. Set Type of Data Input to Enter Table of Counts. In the Variable, Heading box, enter Var. In the Variable, Label of st Value box, enter Yes. In the Variable, Label of nd Value box, enter o. In the Variable, Heading box, enter Var. In the Variable, Label of st Value box, enter Yes. In the Variable, Label of nd Value box, enter o. In the Var Yes, Var Yes box, enter 30. In the Var Yes, Var o box, enter 6. In the Var o, Var Yes box, enter 5. In the Var o, Var o box, enter 9. 3 Specify the Summary Reports. Select the Summary Reports tab. Check Counts and Proportions. Check Proportions Analysis. 4 Specify the Difference Reports. Select the Difference Reports tab. Check am RMLE Score under Confidence Intervals of the Difference. Check Wilson Score under Confidence Intervals of the Difference. Set Test Direction to Two-Sided. Set H0 Difference (D0) to 0.0. Check Mcemar Test under Inequality Tests of the Difference 5 Run the procedure. From the Run menu, select Run Procedure. Alternatively, just click the green Run button. 50-4

15 Counts and Proportions Sections Counts and Proportions Var Var Yes o Total Count Count Count Yes o Total p (36/50) p (35/50) Proportions Analysis Statistic Value Variable Event Rate (p) Variable Event Rate (p) Proportion Matching Proportion ot Matching 0.00 Absolute Risk Difference p - p umber eeded to Treat / p - p Relative Risk Reduction p - p /p Relative Risk p/p.086 Odds Ratio o/o.000 These reports document the values that were input, and give various statistics of these values. Confidence Interval of the Difference (P - P) Confidence Intervals of the Difference (P - P) Confidence Lower 95% Upper 95% Confidence Interval Difference C.L. of C.L. of Interval ame p p p - p P - P P - P Width am RMLE Score* Wilson Score This report provides large sample confidence intervals of the difference. Mcemar Inequality Test Two-Sided Tests of the Difference (P - P) H0: P - P 0 vs. Ha: P - P 0 Test Test Reject Statistic Difference Statistic Prob H0 at ame p p p - p Value Level α 0.05? Mcemar o This report provides the Mcemar test. The p-value of the test is the Prob Level. 50-5

16 Plots Section These reports show the marginal totals and proportions of the two variables. 50-6

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