Journal of Research in Biology

ISSN No: Print: 2231 6280; Online: 2231- 6299

An International Scientific Research Journal

Original Research

Journal of Research in Biology

Estimates of sensitivity, specificity, false rates and expected proportion of

population testing positive in screening tests
Authors:
ABSTRACT:
Oyeka Ikewelugo Cyprian
Anaene 1, Okeh Uchechukwu
Marius 2, Igwebuike Victor
Onyiaorah3, Adaora Amaoge
Onyiaorah4 and Chilota
Chibuife Efobi 5
This paper proposes and presents indices used as measures to evaluate or

assess results obtained from diagnostic screening tests. These indices include
sensitivity, specificity, prevalence rates and false rates. We here present statistical
methods for estimating these rates and for testing hypotheses concerning them. An
estimate of the proportion of a population expected to test positive in a diagnostic
screening test is also provided. Further interest is also to estimate the sensitivity and
2. Department of Industrial
Mathematics and Applied
specificity of the test and then the false rates as functions of sensitivity and specificity
Statistics, Ebonyi State
given knowledge or availability of an estimate of the prevalence rate of a condition in
University Abakaliki, Nigeria.
a population. The indices proposed ranges from -1 to 1 inclusively and therefore
3. Department of
enables the researcher to determine if an association exists and if it exists between
Histopathology, Nnamdi
test results and condition as well as whether it is positive and direct or negative and
Azikiwe University Teaching
indirect which will serve as an advantage over the traditional methods. The proposed
Hospital Nnewi Anambra State,
indices provide estimates of the test statistic. When the proposed measures are
Nigeria.
applied, results indicate that it is easier to interpret and understand more than those
4. Department of
obtained using the traditional approaches. In addition, the proposed measure is
Opthalmology, Enugu State
shown to be at least as efficient and hence as powerful as the traditional methods
University Teaching Hospital
Park lane Enugu State, Nigeria. when applied to sample data.
Institution:
1. Department of Applied
Statistics, Nnamdi Azikiwe
University, Awka Nigeria.

5. Department of Haematology,
University of Port Harcourt
Teaching Hospital, Port
Harcourt, Rivers State Nigeria.
Corresponding author:
Okeh Uchechukwu Marius

Email Id:

Web Address:
http://jresearchbiology.com/
documents/RA0391.pdf

Keywords:
Traditional odds ratio, prevalence, sensitivity, specificity, false rates.

Article Citation:
Oyeka Ikewelugo Cyprian Anaene, Okeh Uchechukwu Marius, Igwebuike Victor
Onyiaorah, Adaora Amaoge Onyiaorah and Chilota Chibuife Efobi
Estimates of Sensitivity, Specificity, False Rates and Expected Proportion of Population
Testing Positive in Screening Tests
Journal of Research in Biology (2014) 4(8): 1498-1504
Date:
Received: 06 Nov 2013

Accepted: 15 Jan 2014

Published: 15 Nov 2014

This article is governed by the Creative Commons Attribution License (http://creativecommons.org/

licenses/by/4.0), which gives permission for unrestricted use, non-commercial, distribution and
reproduction in all medium, provided the original work is properly cited.
Journal of Research in Biology
An International
Scientific Research Journal

1498-1504 | JRB | 2014 | Vol 4 | No 8

www.jresearchbiology.com

Anaene et al., 2014

previous results from a gold standard test to actually

INTRODUCTION
In diagnostic screening tests indices used as

have a certain condition in nature from a population and

measures to evaluate or assess results obtained include,

also takes a second random sample of n.2 subjects from

sensitivity and specificity of the test and if the prevalence

the same population Keeping in mind that known or

rate of a condition of interest in a population is known or

believed not to actually have the same condition in

can be estimated from a previous study, also the false

nature, thus giving a total random sample of size

positive and false negative rates of the test as well as the

n=n..=n.1+n.2 subjects to be studied. It is always treated

proportion of the population expected to test positive to

to confirm through a diagnostic screening test for

the condition (Fleiss, 1973; Pepe, 2003). Hence research

whether or not each sampled subjects have or does not

interest is often in statistical methods for estimating

have the condition of interest. Further interest is also to

sensitivity, specificity, false rates and the proportion of a

estimate the sensitivity and specificity of the test and

population expected to test positive to a condition in

then the false rates as functions of sensitivity and

these screening tests. The sensitivity of a test is the

specificity given knowledge or availability of an estimate

proportion of subjects testing positive among the subjects

of the prevalence rate of a condition in a population.

known or believed to actually have a condition in nature,

Now suppose B and B are respectively the

while the specificity of a test is the proportion of subjects

events that a randomly selected subject from a

who actually test negative to a condition among the

population has and does not have a condition in nature.

subjects known or believed not to actually have the

Also let A and A be respectively the events that the

condition in nature. False positive rate of a test is the

randomly selected subject tests positive, and negative to

proportion of subjects who are known or believed not to

the condition in the test. We here assume that the

actually have a condition in nature among the subjects

prevalence rate P(B) of the condition in the population is

testing positive, while false negative rate is the

either known or can be reliably estimated from previous

proportion of subjects who are known or believed to

studies. The results of such a screening test may be

actually have a condition in nature among the subjects

presented in the form of a four fold Table (Table 1).

who never-the-less test negative (Fleiss,1973;Greenberg

In Table 1 above, of the n=n.. sample subjects

et al., 2001;Linn, 2004).Sensitivity and Specificity of a

studied, n.1 subjects are known or believed to have the

test are independent of the population being studied and

condition in nature, that is in B and n.2 are known or

hence independent of the prevalence rate of a condition

B and
believed not to have the condition in nature, that
is B .

in the population. False rates of a test on the other hand

Also n1. subjects respond positive that is in A and n2.

are functions of the prevalence rate of a condition in a

subjects respond negative, thatAisand

in A . Of the n.1

population and hence are dependent on the population of

subjects in B, n11 subjects actually have the condition

interest (Fleiss, 1973;Linn, 2004).

and test positive that is in AB and n21 subjects actually

We

here

present

statistical

methods

for

have the condition but test negative, that is in AB .

estimating these rates and for testing hypotheses

Of the n.2 subjects who are known or believed not to

concerning them. An estimate of the proportion of a

have the condition in nature,n12 subjects who do not have

population expected to test positive in a diagnostic

the condition test positive, that is in A B w h i l e

n22 subjects who do not have the condition in nature also

screening test is also provided.

Given that a researcher collects a random sample

test negative that is in A B. In an actual screening

of n.1 subjects known or believed, perhaps on the basis of

test usually only the total sample size n=n..,n.1 subjects

1499

Journal of Research in Biology (2014) 4(8): 1498-1504

Anaene et al., 2014

Table 1.Format for Presentation of Results of a Diagnostic Screening Test
Screening Test Results

Condition Present

Condition Absent

(A)

(B)
n11

B
n12

Negative ()

n21

n22

n2.

Total (n.j)

n.1

n.2

n..(=n)

Positive

in B, n11 subjects in AB,n.2 subjects in B

a n d n

2 2

subjects in A B are observed and actually known.

The values n12 in AB and n21 in AB are
not

Total
(ni.)
n1.

known or believed not to have the condition in nature.

Notationally, we have that
P(A) = P (AB) + P (AB )

known and hence also are n1. and n2., the overall number

3
Now to develop sample estimates of these indices,

of subjects who would test positive and negative

sensitivity for instance, we may let,

respectively in the screening test. Hence only the known

values namely total sample size n, the number of

1, if the ith randomly selected and screened

subject known or believed to actually
have a condition in nature tests positive

ui1

subjects, n.1 known to have the condition in nature, n11,

0, otherwise

the number of subjects who test positive among these

for i

known to have the condition in nature, the number of

Let
Let
1=1 P (ui1 =P
1) ui1
and
and

subjects n.2 known not to have the condition in nature

and n22 subjects who test negative among the subjects
known not to have the condition in nature are used here
to estimate the required indices and test statistics. Now

1, 2,...n.1 subjects

n1.

Wi =
W
1

ui1

the sensitivity (Se) and specificity (Sp) of a screening

test expressed in terms of conditional probabilities or

Now the expected value and variances of

specific rates of events A and B are respectively

E ui1

Se

P ( A / B ); Sp

P( A / B )

The higher Se and Sp are more sensitive and

specific is the screening test, the lower these rates, the
weaker are the sensitivity and specificity of the test. The
false positive rate

: Var ui1

ui1

are

Similarly the expected value and variance of are

respectively
n1.

E W1

E (ui1 )

n.1

i 1

and the false negative rate of a

;Var W1

n1.
i 1

Var (ui1 )

n.1

screening test also expressed in terms of conditional

Now 1 is the probability that a randomly

probabilities or specific rates of events A and B are

selected and screened subject known or believed to have

respectively

a condition in nature in a population tests positive; that is

F ve P( B / A)

1 P( A / B ) P( B )
P( A)

; F ve P( B / A)

1 P( A / B ) P ( B )
P( A)

the proportion of subjects testing positive among the

2

subjects in the population known or believed to actually

Where P(A) consists of the probability of

have a condition in nature. This is in fact a measure of

composition of the events AB and which is the

the sensitivity Se of the screening test. The sample

probability of the union of events that a randomly

estimate

selected subject tests positive and is known or believed

to have a condition in nature or tests positive and is
Journal of Research in Biology (2014) 4(8): 1498-1504

Se

of 1 is
W1
n.1

f
n.1

1500

Anaene et al., 2014

Where f+ is the number of subjects who test

condition given that the subject is known or believed not

positive among subjects in the population known or

to actually have the condition in nature. In other words,

believed to have the condition of interest in nature. In

2 is the proportion of subjects testing negative among

other words, f is the number of 1s in the frequency

the population of subject known or believed not to have a

distribution of the n.1values of 1s and 0s in ui1,for i=1,2,

condition in nature. Thus 2 is actually a measure of the

,n.1.Hence f =n11 of Table 1.

specificity Sp of the screening test. Its sample estimate is

The corresponding variance of is from equation (8)

from equation (18)

Var W1

Var Se

Var 1

n.11

(1 Se
)
Se
10
n.1

1 (1 1 )
n.1

W2
n.2

10 Se

A researcher may sometimes wish to test a null

Where f

f
n.2
-

19

is the number of subjects whose test

hypothesis that sensitivity of a screening test is at most

negative among the n.2 subjects in the sampled

some

population known or believed not to have a condition in

value 10 = Se0 . That is the null hypothesis,

11

11other words f - is the total number of 1s in the

nature. In

This null hypothesis may be tested using the test statistic

frequency distribution of the n.2 values of 0s and 1s in

H 0 : Se

Seo

W1

10

n.1 Seo

versus H1 : Se

Seo(0

n.1 Se

Seo

(1
Se

)
Se

Var W1

Seo

1)

10

1 (1

1 )

n.1

ui2,for i=1,2,n.2.Thus f - = n22 in Table 1. The variance

12

Which under Ho has approximately the chi-square

distribution with one (1) degree of freedom for

12

of equation 2
Var

Sp

Var (W2 )
n.22

Var Sp

(18)
(1 Sp
)
Sp
n.2

2 (1 2 )
n.2

20

sufficiently large n.1.the null hypothesis Ho is rejected at

A researcher may also wish to test a null hypothesis that

the level of significance if

specificity Sp of a diagnostic screening test is at least

2
1

13

;1

some value That is the null hypothesis

Ho : Sp

Similarly to develop a sample estimate of the specificity

ui 2

0, otherwise
for i

14

1, 2,...n.2 subjects

15

And
W2

n.2

16

ui 2

;Var ui 2

17

And
n.2

;Var W2

n.2

(1

18

Note that 2 is the probability that a randomly

selected and screened subject tests negative to the
1501

21

W2

n.2 Spo

Var W2

n.2 Sp

Spo

(1
Sp

)
Sp

n.2

20

2 (1

2 )

22

Which under Ho has approximately the chisquare distribution with one (1) degree of freedom for
at the level of significance if equation (13) is satisfied,
15
otherwise Ho is accepted.
a population expected to
16test positive to a condition in a
diagnostic screening test, we note that when expressed in

Now

E W2

1)

To develop sample estimate of the proportion of

i 1

E ui 2

Sp

sufficiently large n.2. The null hypothesis Ho is rejected

Define
P ui 2

13

Spo, (0

This null hypothesis is tested using test statistic

Sp of a screening test, we may let

1, if the ith randomly selected and screened
subject in the population is known or believed not to actually
have a condition in nature tests negative

Spo versus H1 : Sp

20

terms of conditional probability using Bayes rule

17
equation (3) becomes
P( A) P( A / B).P( B) P( A / B ).P( B ) P( A / B).P( B)

1 P( A / B ) 1 P( B)

23

18
Or when expressed in terms of sensitivity Se and
specificity Sp of the screening test and prevalence rate
P(B) of a condition in a population becomes
Journal of Research in Biology (2014) 4(8): 1498-1504

22

Anaene et al., 2014

24

The null hypothesis Ho is expected at the level of

The sampled estimate of P(A) is using equation ( 9) and

significance if equation (13) is satisfied; otherwise Ho is

equation (19) in equation (24)

accepted.

P( A) SeP( B) (1 Sp).P( B) 1 P( A / B) 1 P( A / B) P( A / B) .P( B) 1 Sp 1 Se Sp .P( B)

P ( A)

P( A)

( B)
SeP

).P( B )
(1 Sp

1 Sp

1 Se

.P( B)
Sp

25

The corresponding sample variance is

)( P( B))
Var ( P( A)) Var (Se

) P(( B))
Var (Sp

of false rates in a diagnostic screening test if the

)
2P( B).P( B).Cov SeSp

The researcher may also wish to obtain sample estimates

26

It is easily shown that

prevalence rate P(B) of a condition in a population is

known or can be determined.

; Sp
)
Cov ( Se

Cov

W1 W2
;
n.1 n.2

Now from equations (2) and (25), the sample estimate of

false positive rate in terms of sample estimates of

To prove this it is sufficient to show that

sensitivity and specificity and the known or estimated

Cov ui1 ; ui 2

prevalence rate is

Now
Cov ui1 ; ui 2

E ui1 .ui 2

E (ui1 ).E (ui 2 )

E ui1 .ui1

1. 2 .

Now ui1 .ui1can assume only the values 1 and 0 .

It assumes the value 1 if ui1 and ui2both assume the value
1 with probability it assumes the value 0 if assumes
the values 1 and ui2 assumes the value 0 or ui1 assumes

(1
ve

).P( B )
Sp
P( A)

Sp

Se

Sp

P( B)
.P( B)
Sp

31

Similarly the sample estimate of false negative rate is

from equations (2) and (25)

).P( B)
Se
P ( A)

(1
ve

Sp

P( B)
Se

Se

32

.P( B)
Sp

the value 0 and ui2 assumes the value 1 with probability

Where e and p are given in equation (30).

1(1-2) - 2(1-1) Hence

Finally with further interest the researcher may use some

Cov ui1 ; ui 2
) Var ( Sp
)
Var ( P( A)) Var ( Se

(1 Se
) Sp
(1 Sp
)
Se
n.1
n.2

0 so that
1 (1 1 )
n.1

elementary calculus or apply Fiellers convenience

2 (1 2 )
n.2

27

Theory to obtain approximate estimates of the variances

of F ve and F ve and also test any desired hypotheses.

The researcher may also wish to test the null

hypothesis that the proportion P(A) of

subjects in a

ILLUSTRATIVE EXAMPLE

population expected to test positive to a condition in a

It a clinician is collecting a random sample of 98

diagnostic screening test is at most some value Po(A).

subjects from a certain population; twelve of whom are

That is the null hypothesis

doubted for having prostrate cancer and 86 of whom are

Ho : P( A)

Po( A) versus H1 : P( A)

Po( A), (0

Po( A) 1)

28

This null hypothesis is tested using the test statistic

P ( A)

Var

Po( A)

assumed not to28have the disease. The clinicians interest

is to confirm through a diagnosis screening test whether
or not each of the sampled subjects are actually prostrate

29

P ( A)

29

cancer positive or negative. The results of the screening

test are presented in Table 2.

Which under Ho has approximately the chi-square

Now from Table 2 we have that the sample

distribution with one (1) degree of freedom where P(A)

estimate of the sensitivity and specificity of the test are

and Var (P(A)) are given by equations (25) and (26)

respectively

respectively and from Table 1

Se

f1
n.1

n11
; Sp
n.1

Se

f2
n.2

n22
n.2

Journal of Research in Biology (2014) 4(8): 1498-1504

30

f
n.1

and

Sp

f
n.2

98 4

98
12

n.1
n

f
n.2

8.167

0.041

0.335

30
n

98 84
86

98

1.140

0.857

0.977.

1502

31

Anaene et al., 2014

These results show that the screening test is low

Table 2: Result of Prostrate Cancer Screening Test

in sensitivity but has high specificity.

Clinical diagnosis

Present (B)

Now from equations (13) and (14) the sample estimates

Prostrate Cancer

n11=f + +=4

Absent B
n12=f+ - =4

n1.= 6

of are respectively

Positive (A)

n21=f - +=4

n22=f - - =4

n2.=92

Negative ()

n.1=12

n.2=86

n..=n=98

12 0.335

86 0.977

0.898

98

and
12 1 0.335

86 1 0.977

0.102

98

Hence from equations (15) and (17) we have that

0.898 0.102

0.796

expected to be correctly informed. This probably makes

more difficulty in understanding than the simple
information conveyed by the simple difference in rates,

0.796,

namely, the proportion of subjects

With estimated variance obtained from equations (16)

testing positive among subjects who have prostrate

and (18) as

cancer or testing negative among subjects who do not

Var ( )

Var (

1 (0.796)
98

0.004

have prostrate cancer is 79.6 percent higher than the

proportion of subjects testing positive among subjects

Hence the test statistic of no association between

who do not have prostrate cancer or testing negative

screening test results and state of nature or condition

among subjects who have the disease.

(Prostrate Cancer) of equation (19) are obtained from

equation (20) as

0.796

Se(O)

1
n11

1
n12

1
n21

1
n22

21.00

1
4

1
2

1
8

1
84

(21.00)(0.942) 19.782

0.634
158.500( P value 0.0000)
0.004
0.004
Which with one (1) degree of freedom is highly

This measure of the error of O namely 19.782

statistically significant indicating a strong degree of

Se

association between screening test results and state of

sample data. The chi-square test statistic for the

nature or condition (presence of Prostrate cancer in

significance of O is

the population). Also since

0.796

is positive, the association is positive and direct.

is clearly much larger than the error of only

X2=

0.004

0.063

of the estimated value of for our

n(n11n22n12 n21)2 98(94)(84)-(2)(8)2

=

n1.n2.n1.n2

=17.616 (p-value=0.0000)

(6)(92)(12)(86)

It is commendable to compare the present results with

Which is also statistically significant again leading to a

what would have been obtained if we have used the

rejection of the null hypothesis of no association.

traditional odds ratio to analyze the data of Table 2. In

However, the proposed method and the traditional odds

spite of odds ratios short comings as already pointed out

ratio approach explained here (both) lead to a rejection of

above, when used in the analysis of screening test results.

the null hypothesis, the relative sizes of the calculated

The sample estimate of the traditional odds ratio for the

chi-square values suggest that the traditional odds ratio

data of Table 2 is

method is less efficient and likely to lead to an

n11 n22
n12 n21

(4)(84)
(2)(8)

21.00

This means, for every subject who has prostrate cancer

acceptance of a false null hypothesis (Type II Error)

more frequently and hence is likely to be less powerful
than the proposed method.

among tested subjects and erroneously informed that

they are free of the disease (21 subjects) among those
tested and found to have prostrate cancer would be
1503

Journal of Research in Biology (2014) 4(8): 1498-1504

Anaene et al., 2014

CONCLUSION
In this paper, we proposed, developed and
presented a statistical method for measuring the strength
of association between test results and state of nature or
condition in a population expressed to a diagnostic
screening test. The proposed measure is based on only
the sensitivity and specificity of the screening test which
are independent of the population of interest and
estimated using only observed sample values.
The proposed measure which ranges from -1 to 1
can be used to establish whether an association is strong
and direct, strong and indirect or zero estimates of the
standard error. Test statistics for the significance of the
proposed measure are provided. The proposed measure
of association is shown to be easier to interpret and
explain than the traditional odds ratio, and the sample
data used suggest that the measure is at least as efficient
and powerful as the traditional odds ratio.
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JA

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Sorensen

HT.

2010.

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epidemiology, in Teaching Epidemiology: A guide for

teachers in epidemiology, public health and clinical
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Oxford: Oxford University Press, 237-249.
Fleiss JL. 1973. Statistical Method for Rates and
Proportions. John Wiley, New York.
Greenberg RS, Daniels SR, Flanders WD, Eley JW
and Boring JR. 2001. Medical Epidemiology, London:
Lange-McGraw- Hill.

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