Abstract: A multilevel model (allowing for individual risk factors and geo graphic context) is developed for jointly modelling cross-sectional differences in diabetes prevalence and trends in prevalence, and then adapted to provide geographically disaggregated diabetes prevalence forecasts. This involves a weighted binomial regression applied to US data from the Behavioral Risk Factor Surveillance System (BRFSS) survey, specifically totals of diagnosed diabetes cases, and populations at risk. Both cases and populations are dis aggregated according to survey year (2000 to 2010), individual risk factors (e.g., age, education), and contextual risk factors, namely US census division and the poverty level of the county of residence. The model includes a linear growth path in decadal time units, and forecasts are obtained by extending the growth path to future years. The trend component of the model controls for interacting influences (individual and contextual) on changing prevalence. Prevalence growth is found to be highest among younger adults, among males, and among those with high school education. There are also regional shifts, with a widening of the US “diabetes belt”.
Abstract: 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.