Gerontology

Demography

Statistics

Multivariate statistics

Ethnic group

American Community Survey

Census

Anthropology

Small area estimation

Environmental health

Behavioral Risk Factor Surveillance System

Mathematics

Estimator

Geography

Political science

Population

Sociology

Medicine

Equity (law)

Behavioral risk

Journal of Data Science

Information regarding small area prevalence of chronic disease is important for public health strategy and resourcing equity. This paper develops a prevalence model taking account of survey and census data to derive small area prevalence estimates for diabetes. The application involves 32000 small area subdivisions (zip code census tracts) of the US, with the prevalence estimates taking account of information from the US-wide Behavioral Risk Factor Surveillance System (BRFSS) survey on population prevalence differentials by age, gender, ethnic group and education. The effects of such aspects of population composition on prevalence are widely recognized. However, the model also incorporates spatial or contextual influences via spatially structured effects for each US state; such contextual effects are allowed to differ between ethnic groups and other demographic categories using a multivariate spatial prior. A Bayesian estimation approach is used and analysis demonstrates the considerably improved fit of a fully specified compositional-contextual model as compared to simpler 'standard' approaches which are typically limited to age and area effects.

Estimating Small Area Diabetes Prevalence in the US Using the Behavioral Risk Factor Surveillance System