- The method of generating small area estimation (SAE) of the measures is a multilevel statistical modeling framework.
- Specifically, CDC uses an innovative peer-reviewed multilevel regression and poststratification (MRP) approach that links geocoded health surveys and high spatial resolution population demographic and socioeconomic data.
- The approach predicts individual disease risk and health behaviors in a multilevel modeling framework and estimates the geographic distributions of population disease burden and health behaviors.
- A multilevel logistic regression model for each outcome is constructed, which includes individual-level age, sex, race/ethnicity, and education from CDC’s Behavioral Risk Factor Surveillance System (BRFSS), county-level percentage of adults below 150% of the federal poverty level from the 5-year American Community Survey (ACS), and state- and county-level random effects.
- 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 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 CDC’s BRFSS, Census 2010 population counts, annual Census county population estimates, and ACS estimates.
Further information on the PLACES approach and small area estimation methodology can be obtained from:
- Multilevel Regression and Postratification for Small-Area Estimation of Population Health Outcomes: A Case Study of Chronic Obstructive Pulmonary Disease Prevalence Using the Behavioral Risk Factor Surveillance System.[PDF-5.53MB]
- Validation of Multilevel Regression and Postratification Methodology for Small Area Estimation of Health Indicators From the Behavioral Risk Factor Surveillance System.
- Comparison of Methods for Estimating Prevalence of Chronic Diseases and Health Behaviors for Small Geographic Areas: Boston Validation Study, 2013
- Using 3 Health Surveys to Compare Multilevel Models for Small Area Estimation for Chronic Diseases and Health Behaviors
- PLACES: Local Data for Better Health
- The 29 measures include 4 health risk behaviors, 13 health outcomes, 3 health status measures, 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 has a comprehensive definition that includes the background, significance, limitations of the indicator, data source, and limitations of the data resources.
- Measures 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.
- Arthritis among adults aged ≥18 years
- Current asthma prevalence among adults aged ≥18 years
- Depression 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
- All teeth lost among adults aged ≥65 years
- Obesity among adults aged ≥18 years
- Stroke among adults aged ≥18 years
- 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
- Cervical cancer screening 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)