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Multilevel small-area estimation of colorectal cancer screening in the United States
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3 2018
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Source: Cancer Epidemiol Biomarkers Prev. 27(3):245-253
[PDF-630.73 KB]
Details:
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Alternative Title:Cancer Epidemiol Biomarkers Prev
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Description:Background
The US Preventive Services Task Force recommends routine screening for colorectal cancer (CRC) for adults 50-75 years. We generated small-area estimates for being current with CRC screening to examine socio-geographic differences among states and counties. To our knowledge, nationwide county-level estimates for CRC screening are rarely presented.
Methods
We used county data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) (n=251,360 adults), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression mixed models. We post-stratified the data with the US census population data to run Monte-Carlo simulations. We generated county-level screening prevalence estimates nationally and by race/ethnicity, mapped the estimates and aggregated them into state- and national estimates. We evaluated internal consistency of our model state-specific estimates with BRFSS direct state estimates using Spearman correlation coefficients.
Results
Correlation coefficients were ≥0.95, indicating high internal consistency. We observed substantial variations in current CRC screening estimates among the states and counties within states. State mean estimates ranged from 58.2% in Wyoming to 75.03% in Massachusetts. County mean estimates ranged from 40.11% in Alaska to 79.76% in Florida. Larger county variations were observed in various race/ethnicity groups.
Conclusions
State estimates mask county variations. However, both state and county estimates indicate that the country is far behind the “80% by 2018” target.
Impact
County-modeled estimates help identify variation in CRC screening prevalence in the US and guide education and enhanced screening efforts in areas of need including areas without BRFSS direct-estimates.
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Pubmed ID:29500250
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Pubmed Central ID:PMC5836477
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