Westat, Inc, 1600 Research Blvd, RB 1170, Rockville, MD 20850. Email:
Westat, Inc, Rockville, Maryland.
Prev Chronic Dis. 2017 Nov 2;14:E106. doi: 10.5888/pcd14.160572.
States bear substantial responsibility for addressing the rising rates of diabetes and prediabetes in the United States. However, accurate state-level estimates of diabetes and prediabetes prevalence that include undiagnosed cases have been impossible to produce with traditional sources of state-level data. Various new and nontraditional sources for estimating state-level prevalence are now available. These include surveys with expanded samples that can support state-level estimation in some states and administrative and clinical data from insurance claims and electronic health records. These sources pose methodologic challenges because they typically cover partial, sometimes nonrandom subpopulations; they do not always use the same measurements for all individuals; and they use different and limited sets of variables for case finding and adjustment. We present an approach for adjusting new and nontraditional data sources for diabetes surveillance that addresses these limitations, and we present the results of our proposed approach for 2 states (Alabama and California) as a proof of concept. The method reweights surveys and other data sources with population undercoverage to make them more representative of state populations, and it adjusts for nonrandom use of laboratory testing in clinically generated data sets. These enhanced diabetes and prediabetes prevalence estimates can be used to better understand the total burden of diabetes and prediabetes at the state level and to guide policies and programs designed to prevent and control these chronic diseases.
美国各州在应对不断上升的糖尿病和糖尿病前期发病率方面承担着重大责任。然而，利用传统的州级数据来源，一直无法准确地估算包括未确诊病例在内的糖尿病和糖尿病前期的州级流行率。现在有各种新的和非传统的来源可用于估计州级流行率。其中包括扩大样本的调查，这些调查可以支持某些州的州级估计，以及来自保险索赔和电子健康记录的行政和临床数据。这些来源存在方法学挑战，因为它们通常只涵盖部分、有时是非随机的子人群；并非所有个体都使用相同的测量方法；并且它们在病例发现和调整方面使用不同且有限的变量集。我们提出了一种调整新的和非传统的糖尿病监测数据源的方法，以解决这些限制，并提出了我们对 2 个州（阿拉巴马州和加利福尼亚州）的建议方法的结果，作为概念验证。该方法通过对人口覆盖不足的调查和其他数据源进行重新加权，使其更能代表州人口，并调整临床产生的数据集在实验室检测中的非随机使用。这些经过增强的糖尿病和糖尿病前期流行率估计可用于更好地了解州一级糖尿病和糖尿病前期的总体负担，并为预防和控制这些慢性病的政策和计划提供指导。
