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Cancer Epidemiol Biomarkers Prev. 2018 Oct 1. pii: cebp.0367.2018. doi: 10.1158/1055-9965.EPI-18-0367. [Epub ahead of print]

Multilevel regression for small-area estimation of mammography use in the United States, 2014.

Author information

1
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention zab3@cdc.gov.
2
Economic Research Service, U.S. Department of Agriculture.
3
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention.
4
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC).

Abstract

BACKGROUND:

The US Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50 to 74 years. County-level information on population measures of mammography use can inform targeted intervention to reduce geographic disparities in mammography use. County-level estimates for mammography use nationwide are rarely presented.

METHODS:

We used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) (n=130,289 women), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression models with two outcomes: mammography within the past 2 years (up-to-date); and most recent mammography 5 or more years ago or never (rarely/never). We post-stratified the data with US Census population counts to run Monte Carlo simulations. We generated county-level estimates nationally and by urban-rural county classifications. County-level prevalence estimates were aggregated into state and national estimates. We validated internal consistency between our model-based state-specific estimates and urban-rural estimates with BRFSS direct estimates using Spearman correlation coefficients and mean absolute differences.

RESULTS:

Correlation coefficients were 0.94 or larger. Mean absolute differences for the 2 outcomes ranged from 0.79 to 1.03. Although 78.45% (95% CI: 77.95% ─78.92%) of women nationally were up-to-date with mammography, more than half of the states had counties with >15% of women rarely/never using a mammogram, many in rural areas.

CONCLUSIONS:

We provided estimates for all U.S. counties and identified marked variations in mammography use. Many states and counties were far from the 2020 target (81.1%).

IMPACT:

Our results suggest a need for planning and resource allocation on a local level to increase mammography uptake.

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