Berkowitz Z, Zhang X, Richards TB, Sabatino SA, Smith JL, Peipins LA, Nadel M. Multilevel small area estimation for county-level prevalence of colorectal cancer screening test use in the United States using 2018 data.
Ann Epidemiol 2021;
66:20-27. [PMID:
34718132 DOI:
10.1016/j.annepidem.2021.10.003]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE-
National screening estimates mask county-level variations. We aimed to generate county-level colorectal cancer (CRC) screening prevalence estimates for 2018 among adults aged 50-75 years and identify counties with low screening prevalence.
METHODS-
We combined individual-level county data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 204,947) with the 2018 American Community Survey county poverty data as a covariate, and the 2018 U.S. Census county population count data to generate county-level prevalence estimates for being current with any CRC screening test, colonoscopy, and home stool blood test. Because BRFSS is a state-based survey, and because some counties did not have samples for analysis, we used correlation coefficients to test internal consistency between model-based and BRFSS state estimates.
RESULTS-
Correlation coefficients tests were ≥0.97. Model-based national prevalence for any test was 69.9% (95% CI, 69.5% -70.4%) suggesting 30% are not current with screening test use. State mean estimates ranged from 62.1% in Alaska and Wyoming to 76.6% in Maine and Massachusetts. County mean estimates ranged from 42.2% in Alaska to 80.0% in Florida and Rhode Island. Most tests were performed with colonoscopy.
CONCLUSIONS-
Estimates across all U.S. counties showed large variations. Estimates may be informative for planning by states and local screening programs.
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