Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Statistical Research and Applications Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9765, Bethesda, MD 20892. Email:
Prev Chronic Dis. 2019 Aug 29;16:E119. doi: 10.5888/pcd16.190013.
National health surveys, such as the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS), collect data on cancer screening and smoking-related measures in the US noninstitutionalized population. These surveys are designed to produce reliable estimates at the national and state levels. However, county-level data are often needed for cancer surveillance and related research.
To use the large sample sizes of BRFSS and the high response rates and better coverage of NHIS, we applied multilevel models that combined information from both surveys. We also used relevant sources such as census and administrative records. By using these methods, we generated estimates for several cancer risk factors and screening behaviors that are more precise than design-based estimates.
We produced reliable, modeled estimates for 11 outcomes related to smoking and to screening for female breast cancer, cervical cancer, and colorectal cancer. The estimates were produced for 3,112 counties in the United States for the data period from 2008 through 2010.
The modeled estimates corrected for potential noncoverage bias and nonresponse bias in the BRFSS and reduced the variability in NHIS estimates that is attributable to small sample size. The small area estimates produced in this study can serve as a useful resource to the cancer surveillance community.
国家健康调查，如全国健康访谈调查（NHIS）和行为风险因素监测系统（BRFSS），在美国非机构化人群中收集癌症筛查和与吸烟相关措施的数据。这些调查旨在产生国家和州一级的可靠估计。然而，癌症监测和相关研究通常需要县级数据。
为了利用 BRFSS 的大样本量和 NHIS 的高应答率和更好的覆盖范围，我们应用了结合了这两个调查信息的多层次模型。我们还使用了相关来源，如人口普查和行政记录。通过使用这些方法，我们生成了比基于设计的估计更精确的几个癌症风险因素和筛查行为的估计。
我们为 2008 年至 2010 年期间的 11 项与吸烟和女性乳腺癌、宫颈癌和结直肠癌筛查相关的结果生成了可靠的、基于模型的估计。这些估计是针对美国 3112 个县进行的。
模型估计纠正了 BRFSS 中潜在的未覆盖偏差和无应答偏差，并减少了 NHIS 估计中因样本量小而产生的可变性。本研究中产生的小区域估计可以作为癌症监测界的有用资源。
