Estimating County-Level Mortality Rates Using Highly Censored Data From CDC WONDER

Abstract

Introduction: CDC WONDER is a system developed to promote information-driven decision making and provide access to detailed public health information to the general public. Although CDC WONDER contains a wealth of data, any counts fewer than 10 are suppressed for confidentiality reasons, resulting in left-censored data. The objective of this analysis was to describe methods for the analysis of highly censored data.

Methods: A substitution approach was compared with 1) a simple, nonspatial Bayesian model that smooths rates toward their statewide averages and 2) a more complex Bayesian model that accounts for spatial and between-age sources of dependence. Age group-specific county-level data on heart disease mortality were used for the comparisons.

Results: Although the substitution and nonspatial approach provided age-standardized rate estimates that were more highly correlated with the true rate estimates, the estimates from the spatial Bayesian model provided a superior compromise between goodness-of-fit and model complexity, as measured by the deviance information criterion. In addition, the spatial Bayesian model provided rate estimates with greater precision than the nonspatial approach; in contrast, the substitution approach did not provide estimates of uncertainty.

Conclusion: Because of the ability to account for multiple sources of dependence and the flexibility to include covariate information, the use of spatial Bayesian models should be considered when analyzing highly censored data from CDC WONDER.

Figure 1

Estimates of age-standardized heart disease mortality rates from 1980. A, Crude age-standardized rates based solely on the data. B, Estimates obtained by using the approach of Tiwari et al (8). C, Estimated posterior medians from the Poisson-gamma model. D, Estimated posterior medians from the multivariate conditional autoregressive model (MCAR). Data source: Centers for Disease Control and Prevention (18).

Figure 2

Comparison of 3 approaches for estimating age-standardized heart disease mortality rates for 2 age groups (adults aged 35 to 44 and adults aged ≥85) from 1980. A, Estimates for adults aged 35 to 44 obtained by using the approach of Tiwari et al (8). B, Estimated posterior medians for adults aged 35 to 44 from the Poisson-gamma model. C, Estimated posterior medians for adults aged 35 to 44 from the multivariate conditional autoregressive model (MCAR). D, Estimates for adults aged ≥85 obtained by using the approach of Tiwari et al (8). E, Estimated posterior medians for adults aged ≥85 from the Poisson-gamma model. F, Estimated posterior medians for adults aged ≥85 from the multivariate conditional autoregressive model (MCAR). Data source: Centers for Disease Control and Prevention (18).