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Int J Environ Res Public Health. 2013 Dec 27;11(1):418-28. doi: 10.3390/ijerph110100418.

Using small-area analysis to estimate county-level racial disparities in obesity demonstrating the necessity of targeted interventions.

Author information

  • 1Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. dagostinol@wudosis.wustl.edu.
  • 2Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. gennarellir@wudosis.wustl.edu.
  • 3Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. lyonss@wudosis.wustl.edu.
  • 4Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. goodmanm@wudosis.wustl.edu.

Abstract

Data on the national and state levels is often used to inform policy decisions and strategies designed to reduce racial disparities in obesity. Obesity-related health outcomes are realized on the individual level, and policies based on state and national-level data may be inappropriate due to the variations in health outcomes within and between states. To examine county-level variation of obesity within states, we use a small-area analysis technique to fill the void for county-level obesity data by race. Five years of Behavioral Risk Factor Surveillance System data are used to estimate the prevalence of obesity by county, both overall and race-stratified. A modified weighting system is used based on demographics at the county level using 2010 census data. We fit a multilevel reweighted regression model to obtain county-level prevalence estimates by race. We compare the distribution of prevalence estimates of non-Hispanic Blacks to non-Hispanic Whites. For 25 of the 26 states included in our analysis there is a statistically significant difference between within-state county-level average obesity prevalence rates for non-Hispanic Whites and non-Hispanic Blacks. This study provides information needed to target disparities interventions and resources to the local areas with greatest need; it also identifies the necessity of doing so.

PMID:
24378819
PMCID:
PMC3924452
DOI:
10.3390/ijerph110100418
[PubMed - indexed for MEDLINE]
Free PMC Article
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