Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014
Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014
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DOI：
10.1158/1055-9965.epi-18-0367
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发表时间：
2019-01-01
影响因子：
3.8
通讯作者：
White, Mary C.
中科院分区：
文献类型：
--
作者：
Berkowitz, Zahava;Zhang, Xingyou;White, Mary C.
背景：美国预防服务工作组建议对50-74岁的平均风险女性进行两年一次的乳房x光检查。县级乳房x光检查使用人口测量数据可以为有针对性的干预提供信息，以减少乳房x光检查使用的地理差异。很少有关于全国乳腺x光检查使用情况的县级估计。方法：我们使用2014年行为风险因素监测系统（BRFSS, n = 130,289名妇女）的数据，将其与美国社区调查贫困数据联系起来，并拟合具有两个结果的多水平逻辑回归模型：过去2年（最新）的乳房x光检查，以及最近5年或更早的乳房x光检查或从未（很少/从未）。我们将数据与美国人口普查数据进行后分层，以运行蒙特卡洛模拟。我们在全国和城乡县分类中产生了县级估计。县级患病率估计数汇总为州和国家估计数。我们使用Spearman相关系数和平均绝对差值验证了基于模型的特定州估计和城乡估计与BRFSS直接估计之间的内部一致性。结果：相关系数大于等于0.94。两种结果的平均绝对差异为0.79 ~ 1.03。尽管全国78.45%（95%可信区间77.95%-78.92%）的妇女接受了最新的乳房x光检查，但超过一半的州的县有15%的妇女很少或从不进行乳房x光检查，其中许多在农村地区。结论：我们提供了美国所有县的估计数据，并确定了乳房x光检查使用的显著差异。许多州和县远未达到2020年的目标（81.1%）。影响：我们的研究结果表明，需要在地方一级规划和资源分配，以增加乳房x光检查的吸收。
Background: The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 years. County-level information on population measures of mammography use can inform targeted intervention to reduce geographic disparities in mammography use. County-level estimates for mammography use nationwide are rarely presented.Methods: We used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS; n = 130,289 women), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression models with two outcomes: mammography within the past 2 years (up-to-date), and most recent mammography 5 or more years ago or never (rarely/never). We poststratified the data with U.S. Census population counts to run Monte Carlo simulations. We generated county-level estimates nationally and by urban-rural county classifications. County-level prevalence estimates were aggregated into state and national estimates. We validated internal consistency between our model-based state-specific estimates and urban-rural estimates with BRFSS direct estimates using Spearman correlation coefficients and mean absolute differences.Results: Correlation coefficients were 0.94 or larger. Mean absolute differences for the two outcomes ranged from 0.79 to 1.03. Although 78.45% (95% confidence interval, 77.95%-78.92%) of women nationally were up-to-date with mammography, more than half of the states had counties with >15% of women rarely/never using a mammogram, many in rural areas.Conclusions: We provided estimates for all U.S. counties and identified marked variations in mammography use. Many states and counties were far from the 2020 target (81.1%).Impact: Our results suggest a need for planning and resource allocation on a local level to increase mammography uptake.