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Epidemiology · Public Health

Epidemiology: Screening and Diagnostic Testing

Screening test sensitivity, specificity, and predictive value concepts applied to public health screening program decisions.

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What is sensitivity in a screening test?
The proportion of people who truly have the disease who test positive (true positive rate).
What is specificity in a screening test?
The proportion of people who truly do not have the disease who test negative (true negative rate).
What is the formula for sensitivity?
TP / (TP + FN)
What is the formula for specificity?
TN / (TN + FP)
What is positive predictive value (PPV)?
The proportion of people with a positive test result who actually have the disease.
What is negative predictive value (NPV)?
The proportion of people with a negative test result who actually do not have the disease.
What is the formula for positive predictive value?
TP / (TP + FP)
What is the formula for negative predictive value?
TN / (TN + FN)
How does increasing disease prevalence affect PPV, for a test with fixed sensitivity and specificity?
PPV increases as prevalence increases.
How does increasing disease prevalence affect NPV, for a test with fixed sensitivity and specificity?
NPV decreases as prevalence increases.
Does a test's sensitivity change with disease prevalence in the population tested?
No, sensitivity is an intrinsic property of the test and does not depend on prevalence.
Does a test's specificity change with disease prevalence in the population tested?
No, specificity is an intrinsic property of the test and does not depend on prevalence.
What is a highly sensitive test useful for when its result is negative?
Ruling out disease.
What is a highly specific test useful for when its result is positive?
Ruling in disease.
What test characteristic is prioritized for an initial population screening test?
High sensitivity, so as few true cases as possible are missed.

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