Multilevel small-area estimation of colorectal cancer screening in the United States

Details

• Alternative Title:
  Cancer Epidemiol Biomarkers Prev
• Personal Author:
  Berkowitz, Zahava ; Zhang, Xingyou ; Richards, Thomas B. ; Nadel, Marion ; Peipins, Lucy A. ; Holt, James
• 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.
• Subjects:
  • Aged
  • Behavioral Risk Factor Surveillance System
  • Colorectal Neoplasms
  • Early Detection of Cancer
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  More +
• Keywords:
  • multilevel small area estimation
  • county-level estimates
  • colorectal cancer screening
  • colonoscopy
  • fecal occult blood test
  • internal consistency
• Source:
  Cancer Epidemiol Biomarkers Prev. 27(3):245-253
• Pubmed ID:
  29500250
• Pubmed Central ID:
  PMC5836477
• Document Type:
  Text
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Genre:
  Journal Article
• Volume:
  27
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/52365/cdc_52365_DS1.pdf
• File Type:
  [PDF - 630.73 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:796237f493d2d6b6c6358cfb6ab12abf0011aee628bf084bd5a101ff37195b24a2fc5c580675d78bc339392d84d2311ede4c732d0e2a37ca3f9f42bd8dae39ea