252221 Model-based small area estimation of Human papillomavirus (HPV) vaccine coverage among young adult women in Texas

Monday, October 31, 2011: 3:30 PM

Jan M. Eberth, PhD , Department of Biostatistics, M.D. Anderson Cancer Center, Houston, TX
Xingyou Zhang, PhD , National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
Md Monir Hossain, PhD , Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, TX
Jasmin A. Tiro, PhD , Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
James B. Holt, PhD , National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
Sally W. Vernon, PhD , Center for Health Promotion and Prevention Research, University of Texas-Houston School of Public Health, Houston, TX
Introduction: Methods to produce local estimates using data collected for larger regions are known as small area estimation (SAE). We demonstrate the use of multilevel, unit-level SAE to estimate human papillomavirus (HPV) vaccine coverage among females aged 18-26 in Texas counties. Methods: Multilevel (3 level: individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (receipt of >=1 dose Gardasil®/HPV4) from the 2008 Behavioral Risk Factor Surveillance System (outcome and level 1 covariates) and a number of secondary sources (group-level covariates). Using estimated regression coefficients and standard errors from the final model, we simulated 10,000 datasets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county. Results: County level estimates ranged from 1.9-23.8%, with a weighted state average of 11.4% (95% CI: 10.3, 12.5). Coverage amongst young adult females was highest in the Northern and Southeastern counties, and lowest in the Panhandle region of the state. Discussion: Small area analyses have been used in a variety of settings to assess a variety of health outcomes, and as shown in this study, can be used to highlight geographic disparities (and opportunities for intervention) in HPV vaccine coverage. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Cancer Institute.

Learning Areas:
Biostatistics, economics

Learning Objectives:
1. Describe the advantages and limitations of local health data 2. Define small area estimation 3. Differentiate between methods for generating small area estimates 4. Describe how small area estimates are evaluated for accuracy

Keywords: Statistics, Adolescent Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted this research as part of my PhD dissertation in Epidemiology, which was reviewed and approved by a panel of faculty at the University of Texas Health Science Center and UT Southwestern Medical School. My research focuses on geographic disparities in access, utilization, and quality of healthcare in the United States.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.