Dataset Information

Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014.

ABSTRACT:

Background

The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 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 poststratified the data with U.S. 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 two outcomes ranged from 0.79 to 1.03. Although 78.45% (95% confidence interval, 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.

SUBMITTER: Berkowitz Z

PROVIDER: S-EPMC6343124 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014.

Berkowitz Zahava Z Zhang Xingyou X Richards Thomas B TB Sabatino Susan A SA Peipins Lucy A LA Holt James J White Mary C MC

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 20181001 1

<h4>Background</h4>The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 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.<h4>Methods</h4>We used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS; <i>n</i> = 130,289 women), linked it ...[more]

PMID: 30275116

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Project description:ImportanceAccess to appropriate prescription medications, use of inappropriate or ineffective treatments, and adverse drug events are public health concerns among US children and adolescents.ObjectiveTo evaluate trends in use of prescription medications among US children and adolescents.Design, setting, and participantsUS children and adolescents aged 0 to 19 years in the 1999-2014 National Health and Nutrition Examination Survey (NHANES)-serial cross-sectional, nationally representative surveys of the civilian noninstitutionalized population.ExposuresSex, age, race and Hispanic origin, household income and education, insurance status, current health status.Main outcomes and measuresUse of any prescription medications or 2 or more prescription medications taken in the past 30 days; use of medications by therapeutic class; trends in medication use across 4-year periods from 1999-2002 to 2011-2014. Data were collected though in-home interview and direct observation of the prescription container.ResultsData on prescription medication use were available for 38 277 children and adolescents (mean age, 10 years; 49% girls). Overall, use of any prescription medication in the past 30 days decreased from 24.6% (95% CI, 22.6% to 26.6%) in 1999-2002 to 21.9% (95% CI, 20.3% to 23.6%) in 2011-2014 (β = -0.41 percentage points every 2 years [95% CI, -0.79 to -0.03]; P = .04), but there was no linear trend in the use of 2 or more prescription medications (8.5% [95% CI, 7.6% to 9.4%] in 2011-2014). In 2011-2014, the most commonly used medication classes were asthma medications (6.1% [95% CI, 5.4% to 6.8%]), antibiotics (4.5% [95% CI, 3.7% to 5.5%]), attention-deficit/hyperactivity disorder (ADHD) medications (3.5% [95% CI, 2.9% to 4.2%]), topical agents (eg, dermatologic agents, nasal steroids) (3.5% [95% CI, 3.0% to 4.1%]), and antihistamines (2.0% [95% CI, 1.7% to 2.5%]). There were significant linear trends in 14 of 39 therapeutic classes or subclasses, or in individual medications, with 8 showing increases, including asthma and ADHD medications and contraceptives, and 6 showing decreases, including antibiotics, antihistamines, and upper respiratory combination medications.Conclusions and relevanceIn this study of US children and adolescents based on a nationally representative survey, estimates of prescription medication use showed an overall decrease in use of any medication from 1999-2014. The prevalence of asthma medication, ADHD medication, and contraceptive use increased among certain age groups, whereas use of antibiotics, antihistamines, and upper respiratory combination medications decreased.

Dataset Information

Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014.

Background

Methods

Results

Conclusions

Impact

Publications

Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014.

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