Small Area Estimation of Cancer Risk Factors and Screening Behaviors in US Counties by Combining Two Large National Health Surveys

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A scatter plot shows the ratios of the county-level BRFSS direct estimates, after adjusting for the difference between BRFSS and NHIS, to the modeled estimates of breast cancer screening for households with landline telephones, 2008–2010, against the county-level BRFSS effective sample size with a logscale. The ratios, on the y-axis, ranged from 0 to 1.7 and the log of BRFSS effective sample size, on the x axis, ranged from 0 to 8. The plots show a funnel shape around the horizontal line where ratio equals 1, with the widest range being on the left side where the BRFSS effective sample size approaches 0. The ratios shrink to 1 when the BRFSS effective sample size gets larger. The ratios are all close to 1 when the log of BRFSS effective sample size is ≥5. Effective sample size was computed using sample size divided by the estimated design effect.

Figure 1.
Ratio of Behavioral Risk Factor Surveillance System (BRFSS) direct estimates, after adjusting the difference between BRFSS and the National Health Interview Survey (NHIS), to the modeled estimates of breast cancer screening for households with landline telephones, 2008–2010.

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A bubble chart shows the county-level lung cancer mortality rate per 100,000 among adults aged 18 or older for 2011–2015 on the y axis against the county-level current smoking prevalence for 2008–2010 on the x axis. County-level lung cancer mortality rate ranged from 13 per 100,000 to 183 per 100,000. County-level current smoking prevalence ranged from 6.8% to 43.0%. The plot shows a strong positive linear relationship between current smoking prevalence and lung cancer mortality.

Figure 2.
Bubble chart of county-level age-adjusted mortality rates (per 100,000) for 2011–2015 versus current smoking prevalence for 2008–2010 for adults aged 18 or older.

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