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Methodology

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Methodology:

  • The method of generating small area estimation (SAE) of the measures is a multi-level statistical modeling framework.
  • Specifically, CDC will use an innovative peer-reviewed multi-level regression and poststratification (MRP) approach that links geocoded health surveys and high spatial resolution population demographic and socioeconomic data.
  • The approach also accounts for the associations between individual health outcomes, individual characteristics, and spatial contexts and factors at multiple levels (e.g., state, county); predicts individual disease risk and health behaviors in a multi-level modeling framework, and estimates the geographic distributions of population disease burden and health behaviors.
  • The MRP approach is flexible and will help CDC provide modeled estimates of the prevalence for each indicator at the census tract and city levels.
  • Small area estimates using this MRP approach have been published using data from CDC’s Behavioral Risk Factor Surveillance System (BRFSS) and the National Survey of Children’s Health.
  • CDC’s internal and external validation studies confirm the strong consistency between MRP model-based SAEs and direct BRFSS survey estimates at both state and county levels.
  • The primary data sources for this project are the CDC Behavioral Risk Factor Surveillance System, the Census 2010 population, and the American Community Survey estimates.

Further information on the small area estimation methodology can be obtained from:

Measures:

  • The 27 measures include 5 unhealthy behaviors, 13 health outcomes, and 9 prevention practices.
  • The measures include major risk behaviors that lead to illness, suffering, and early death related to chronic diseases and conditions, as well as the conditions and diseases that are the most common, costly, and preventable of all health problems.
  • Each measure will have a comprehensive definition that includes the background, significance, limitations of the indicator, data source, and limitations of the data resources.
  • Measures will complement existing sets of surveillance indicators that report state, metropolitan area, and county-level data, including County Health Rankings, Chronic Disease Indicators, and Community Health Status Indicators.

500 Cities Measures:

Unhealthy Behaviors

  • Binge drinking among adults aged ≥18 years
  • Current smoking among adults aged ≥18 years
  • No leisure-time physical activity among adults aged ≥18 years
  • Obesity among adults aged ≥18 years
  • Sleeping less than 7 hours among adults aged ≥18 years

Health Outcomes

  • Arthritis among adults aged ≥18 years
  • Current asthma among adults aged ≥18 years
  • High blood pressure among adults aged ≥18 years
  • Cancer (excluding skin cancer) among adults aged ≥18 years
  • High cholesterol among adults aged ≥18 years who have been screened in the past 5 years
  • Chronic kidney disease among adults aged ≥18 years
  • Chronic obstructive pulmonary disease among adults aged ≥18 years
  • Coronary heart disease among adults aged ≥18 years
  • Diagnosed diabetes among adults aged ≥18 years
  • Mental health not good for ≥14 days among adults aged ≥18 years
  • Physical health not good for ≥14 days among adults aged ≥18 years
  • All teeth lost among adults aged ≥65 years
  • Stroke among adults aged ≥18 years

Prevention

  • Current lack of health insurance among adults aged 18-64 years
  • Visits to doctor for routine checkup within the past year among adults aged ≥18 years
  • Visits to dentist or dental clinic among adults aged ≥18 years
  • Taking medicine for high blood pressure control among adults aged ≥18 years with high blood pressure
  • Cholesterol screening among adults aged ≥18 years
  • Mammography use among women aged 50-74 years
  • Papanicolaou smear use among adult women aged 21-65 years
  • Fecal occult blood test, sigmoidoscopy, or colonoscopy among adults aged 50-75 years
  • Older adults aged ≥65 years who are up to date on a core set of clinical preventive services (Men: Flu shot past year, Pneumococcal polysaccharides vaccine (PPV) shot ever, Colorectal cancer screening; Women: Same as above, and Mammogram past 2 years)
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