Krause Denise D, May Warren L, Cossman Jeralynne S
University of Mississippi Medical Center.
Online J Public Health Inform. 2012;4(3). doi: 10.5210/ojphi.v4i3.4279. Epub 2012 Dec 19.
The objective of our study of oral health disparities in Appalachia was to use existing data sources to geographically analyze suspected disparities in oral health status in the 420 counties of Appalachia, and to make sub-state comparisons within Appalachia and to the rest of the nation. The purpose of this manuscript is to describe the methods used to overcome challenges associated with using limited oral health data to make inferences about oral health status.
Oral health data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS). Because the BRFSS was designed for state-level analysis, there were inadequate numbers of responses to study Appalachia by county. We set out to determine the smallest possible unit we could use, aggregating data to satisfy CDC minimum requirements for spatially identified responses. For sub-state comparisons, data were first aggregated to Appalachian and non-Appalachian regions within Appalachian states. Next, urban versus rural areas within Appalachian and non-Appalachian regions were examined. Beale codes were used to define metropolitan and non-metropolitan statistical regions for the United States.
Aggregating the data as described proved useful for smoothing the data used to analyze oral health disparities, while still revealing important sub-state differences. Using geographic information systems to map data throughout the process was very useful for determining an effective approach for our analysis.
Studying oral health disparities on a regional or national level is difficult given a lack of appropriate data. The BRFSS can be adapted for this purpose; however, there is a limited number of oral health questions and because they are also optional, they are not routinely asked by all states. Expanding the BRFSS to include a larger sampling frame would be very helpful for studying oral health disparities.
Novel techniques were introduced to use BRFSS data to study oral health disparities in Appalachia, which provided informative sub-state results, useful to health planners for targeting intervention strategies.
我们对阿巴拉契亚地区口腔健康差异进行研究的目的是利用现有数据源，对阿巴拉契亚地区420个县的口腔健康状况疑似差异进行地理分析，并在阿巴拉契亚地区内部以及与美国其他地区进行州以下层面的比较。本手稿的目的是描述为克服利用有限的口腔健康数据推断口腔健康状况所带来的挑战而采用的方法。
口腔健康数据取自行为危险因素监测系统（BRFSS）。由于BRFSS是为州层面分析设计的，按县对阿巴拉契亚地区进行研究时得到的回复数量不足。我们着手确定可使用的最小可能单位，汇总数据以满足疾病控制与预防中心对空间识别回复的最低要求。为进行州以下层面的比较，数据首先汇总到阿巴拉契亚州内的阿巴拉契亚和非阿巴拉契亚地区。接下来，对阿巴拉契亚和非阿巴拉契亚地区内的城市与农村地区进行了考察。使用比尔代码来定义美国的大都市和非大都市统计区域。
如所述汇总数据被证明有助于平滑用于分析口腔健康差异的数据，同时仍能揭示重要的州以下层面差异。在整个过程中使用地理信息系统来绘制数据图对于确定有效的分析方法非常有用。
鉴于缺乏适当数据，在区域或国家层面研究口腔健康差异很困难。BRFSS可为此目的进行调整；然而，口腔健康问题数量有限，且由于这些问题也是可选的，并非所有州都会常规询问。扩大BRFSS以纳入更大的抽样框架对于研究口腔健康差异将非常有帮助。
引入了新技术来利用BRFSS数据研究阿巴拉契亚地区的口腔健康差异，这提供了信息丰富的州以下层面结果，对卫生规划者制定干预策略目标很有用。
