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Skewness

A measure describing a distribution's asymmetry around its mean, positive skewness meaning a longer tail toward higher values.

Last reviewedDarrin Baines IP Ltd

Concept Architecture

Concept


Theoretically, Skewness is a statistical measure that quantifies the degree and direction of asymmetry in a probability distribution relative to its mean. A symmetric distribution has zero skewness, whereas positive skewness indicates a longer right tail and negative skewness indicates a longer left tail. Skewness is an important descriptive characteristic because departures from symmetry influence statistical estimation, hypothesis testing, and model selection, particularly in analyses of healthcare costs and resource utilisation where highly skewed distributions are common.

Mathematically, skewness is defined as the standardised third central moment of a distribution. It measures the extent to which observations deviate asymmetrically from the mean relative to the standard deviation. Sample skewness is estimated using recognised moment-based estimators, with bias-corrected forms commonly employed for finite samples.

In practice, skewness is calculated during exploratory data analysis to assess distributional assumptions and determine the suitability of statistical models. In health economics it is routinely evaluated for costs, lengths of stay, healthcare utilisation, and quality-adjusted life years, guiding decisions regarding transformations, generalised linear models, non-parametric methods, or bootstrapping.

Purpose


Used to quantify the asymmetry of a distribution, evaluate statistical assumptions, guide model selection, identify highly skewed outcomes, and support appropriate analytical methods in health economic research.


Mathematical Formulae

Primary Formula

Population skewness:

?? = E[(X ? ?)?] � �?

where:

  • ?? = population skewness
  • ? = population mean
  • � = population standard deviation

Supporting Formulae

Sample skewness:

g? = [(1/n) ? ?(x? ? x?)?] � s?

Bias-corrected sample skewness:

G? = [�(n(n ? 1)) � (n ? 2)] ? g?

Related Mathematical Methods

  • Central Moments
  • Standard Deviation
  • Kurtosis
  • Descriptive Statistics
  • Distribution Assessment
  • Normality Assessment
  • Box-Cox Transformation
  • Generalised Linear Models

Example

Annual healthcare costs are analysed for 500 patients.

The sample mean is:

�8,450

The sample standard deviation is:

�4,200

The calculated sample skewness is:

G? = 2.15

The positive skewness indicates a strongly right-skewed cost distribution, with a relatively small number of patients incurring exceptionally high healthcare costs. This suggests that methods assuming Normality may be inappropriate and that alternative approaches, such as bootstrapping or gamma regression, should be considered.


Excel Implementation

FunctionExample FormulaHealth Economics Application
SKEW=SKEW(B2:B501)Calculate sample skewness of healthcare costs or QALYs.
SKEW.P=SKEW.P(B2:B501)Calculate population skewness where the full population is observed.
AVERAGE=AVERAGE(B2:B501)Calculate the sample mean required for descriptive analysis.
STDEV.S=STDEV.S(B2:B501)Calculate the sample standard deviation used in skewness estimation.
HISTOGRAM*Data Analysis ? HistogramVisually assess asymmetry in healthcare outcomes.

*Available through the Excel Analysis ToolPak.

VBA (Optional)

Automate calculation of skewness statistics across multiple health economic variables and flag highly skewed distributions requiring alternative analytical methods.


Sources

  • Joanes DN, Gill CA. Comparing Measures of Sample Skewness and Kurtosis. Journal of the Royal Statistical Society: Series D (The Statistician). 1998.
  • Zwillinger D, Kokoska S. CRC Standard Probability and Statistics Tables and Formulae.
  • Altman DG. Practical Statistics for Medical Research.
  • Briggs A, Claxton K, Sculpher M. Decision Modelling for Health Economic Evaluation.
  • Drummond MF, et al. Methods for the Economic Evaluation of Health Care Programmes.
  • NICE Health Technology Evaluation Manual.

Library

Publications

1
  • Book

    Bayesian Methods in Health Economics — Gianluca Baio, 1st Edition ed., 2012 (Chapman & Hall / CRC Press)

    An overview of Bayesian statistical methods for the analysis of health economic data, covering economic evaluation concepts, statistical cost-effectiveness analysis, Bayesian computation and MCMC, and applied health economic evaluation.

Frequently Asked Questions (6)

  • What is skewness?

    A measure describing a distribution's asymmetry around its mean, positive skewness meaning a longer tail toward higher values.

    Source: Pearson 1895

  • What does skewness describe about a distribution's shape?

    Skewness describes the asymmetry of a distribution around its centre, indicating whether it leans to one side. Positive skewness means a long tail stretching toward higher values, as with incomes or costs where a few large figures pull the tail out to the right, while negative skewness has the tail toward lower values. Unlike kurtosis, which concerns the weight of the tails, skewness is about lopsidedness, and it matters because a skewed distribution makes the mean an unreliable summary. The lopsidedness of a distribution is what it captures. Kirkwood and Sterne (2003) describe this.

    Source: Kirkwood & Sterne 2003

  • How is skewness interpreted?

    Skewness is interpreted by its sign and magnitude: positive skewness indicates a longer right tail, so the mean is typically pulled above the median, while negative skewness indicates a longer left tail, with the mean below the median; values near zero indicate near symmetry. So skewness is interpreted as showing the direction and extent of a distribution's asymmetry, with the sign giving the direction of the longer tail and the magnitude the degree, which matters because skewness affects the choice of summary statistics and methods, since for skewed data the median is often preferred over the mean and non-parametric methods over parametric ones.

    Source: Pearson 1895

  • How does skewness differ from kurtosis?

    Skewness describes the asymmetry of a distribution, whether it leans to one side with a longer tail in one direction, while kurtosis describes the tailedness, how heavy or light the tails are and the propensity for extreme values. Skewness concerns lopsidedness; kurtosis concerns the weight of the tails. So skewness and kurtosis are distinct aspects of distributional shape, with skewness based on the third moment and kurtosis on the fourth, and both complement measures of centre and spread, since fully describing a distribution considers its central tendency, dispersion, asymmetry through skewness, and tailedness through kurtosis.

    Source: Pearson 1895

  • Why does skewness matter?

    Skewness matters because it affects which summary statistics and statistical methods are appropriate: for skewed data, the mean is pulled toward the longer tail and can be misleading, so the median is often preferred, and parametric methods assuming symmetry or normality may be invalid, favouring non-parametric alternatives or transformations. So skewness matters for describing data accurately and choosing suitable analyses, since ignoring skewness can lead to misleading summaries and invalid inference, which is why the skewness of data is examined, and why skewed distributions are often summarised with the median and interquartile range and analysed with methods robust to asymmetry.

    Source: Pearson 1895

  • How is skewness measured?

    Skewness is measured from the third standardised moment of the distribution, the average of the cubed deviations from the mean divided by the standard deviation cubed, giving a value whose sign indicates the direction of asymmetry and whose magnitude indicates its degree, with zero for a symmetric distribution. So skewness is measured through the third moment, and it can also be assessed by comparing the mean and median or by graphical means such as histograms, though the moment-based measure gives a single number, which is estimated from sample data, with such estimates being sensitive to outliers and sample size, considerations taken into account when interpreting them.

    Source: Casella & Berger 2002

Trust Record

Verified by Dr Darrin Baines

British health economist

Professional identity: darrinbaines.org

Verification date: 25 Dec 2025

Content version: 1.0.0

Canonical Identity

Term code
HE-ES-SA-197

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