Multilevel Small-Area Estimation of Colorectal Cancer Screening in the United States.
Multilevel Small-Area Estimation of Colorectal Cancer Screening in the United States.
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DOI：
10.1158/1055-9965.epi-17-0488
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Holt J
中科院分区：
文献类型：
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作者：
Berkowitz Z;Zhang X;Richards TB;Nadel M;Peipins LA;Holt J
美国预防服务工作组建议对50-75岁的成年人进行结肠直肠癌（CRC）的常规筛查。我们生成了当前CRC筛查的小区域估计值，以检查州和县之间的社会地理差异。据我们所知，全国县级CRC筛查的估计很少。我们使用来自2014年行为风险因素监测系统（BRFSS）的县数据（n= 251，360名成年人），将其与美国社区调查贫困数据联系起来，并拟合多水平logistic回归混合模型。我们使用美国人口普查数据对数据进行后分层，以运行蒙特-卡罗模拟。我们生成了全国和种族/民族的县级筛查患病率估计值，绘制了估计值并将其汇总为州和国家估计值。我们使用斯皮尔曼相关系数评估了我们的模型状态特定估计与BRFSS直接状态估计的内部一致性。相关系数≥0.95，表明内部一致性较高。我们观察到目前的CRC筛查估计在各州和县之间存在很大差异。州平均估计值从怀俄明州的58.2%到马萨诸塞州的75.03%不等。县平均估计值从阿拉斯加的40.11%到佛罗里达的79.76%不等。在不同种族/族裔群体中观察到较大的县差异。国家估计掩盖县的差异。然而，州和县的估计都表明，该国远远落后于“到2018年达到80%”的目标。县模型估计值有助于确定美国CRC筛查患病率的变化，并指导教育和加强筛查工作，包括没有BRFSS直接估计值的地区。
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. 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. 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. State estimates mask county variations. However, both state and county estimates indicate that the country is far behind the “80% by 2018” target. 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.