Best Practices for Binary and Ordinal Data Analyses

The measurement of many human traits, states, and disorders begins with a set of items on a questionnaire. The response format for these questions is often simply binary (e.g., yes/no) or ordered (e.g., high, medium or low). During data analysis, these items are frequently summed or used to estimate factor scores. In clinical applications, such assessments are often non-normally distributed in the general population because many respondents are unaffected, and therefore asymptomatic. As a result, in many cases these measures violate the statistical assumptions required for subsequent analyses. To reduce the influence of the non-normality and quasi-continuous assessment, variables are frequently recoded into binary (affected-unaffected) or ordinal (mild-moderate-severe) diagnoses. Ordinal data therefore present challenges at multiple levels of analysis. Categorizing continuous variables into ordered categories typically results in a loss of statistical power, which represents an incentive to the data analyst to assume that the data are normally distributed, even when they are not. Despite prior zeitgeists suggesting that, e.g., variables with more than 10 ordered categories may be regarded as continuous and analyzed as if they were, we show via simulation studies that this is not generally the case. In particular, using Pearson product-moment correlations instead of maximum likelihood estimates of polychoric correlations biases the estimated correlations towards zero. This bias is especially severe when a plurality of the observations fall into a single observed category, such as a score of zero. By contrast, estimating the ordinal correlation by maximum likelihood yields no estimation bias, although standard errors are (appropriately) larger. We also illustrate how odds ratios depend critically on the proportion or prevalence of affected individuals in the population, and therefore are sub-optimal for studies where comparisons of association metrics are needed. Finally, we extend these analyses to the classical twin model and demonstrate that treating binary data as continuous will underestimate genetic and common environmental variance components, and overestimate unique environment (residual) variance. These biases increase as prevalence declines. While modeling ordinal data appropriately may be more computationally intensive and time consuming, failing to do so will likely yield biased correlations and biased parameter estimates from modeling them.