Using small-area analysis to estimate county-level racial disparities in obesity demonstrating the necessity of targeted interventions

Lucy D'Agostino-McGowan, Renee L. Gennarelli, Sarah A. Lyons, Melody S. Goodman

Research output: Contribution to journalArticle

Abstract

Data on the national and state levels is often used to inform policy decisions and strategies designed to reduce racial disparities in obesity. Obesity-related health outcomes are realized on the individual level, and policies based on state and national-level data may be inappropriate due to the variations in health outcomes within and between states. To examine county-level variation of obesity within states, we use a small-area analysis technique to fill the void for county-level obesity data by race. Five years of Behavioral Risk Factor Surveillance System data are used to estimate the prevalence of obesity by county, both overall and race-stratified. A modified weighting system is used based on demographics at the county level using 2010 census data. We fit a multilevel reweighted regression model to obtain county-level prevalence estimates by race. We compare the distribution of prevalence estimates of non-Hispanic Blacks to non-Hispanic Whites. For 25 of the 26 states included in our analysis there is a statistically significant difference between within-state county-level average obesity prevalence rates for non-Hispanic Whites and non-Hispanic Blacks. This study provides information needed to target disparities interventions and resources to the local areas with greatest need; it also identifies the necessity of doing so.

Original languageEnglish (US)
Pages (from-to)418-428
Number of pages11
JournalInternational journal of environmental research and public health
Volume11
Issue number1
DOIs
StatePublished - Dec 27 2013

Keywords

  • Disparities
  • Multilevel regression
  • Obesity
  • Small-area analysis
  • Targeted interventions

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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