title: Using small-area analysis to estimate county-level racial disparities in obesity demonstrating the necessity of targeted interventions.
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.
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. dagostinol@wudosis.wustl.edu.
authors.forename: Lucy
authors.initials: L
authors.lastname: D'Agostino-McGowan
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. gennarellir@wudosis.wustl.edu.
authors.forename: Renee L
authors.initials: RL
authors.lastname: Gennarelli
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. lyonss@wudosis.wustl.edu.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Lyons
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. goodmanm@wudosis.wustl.edu.
authors.forename: Melody S
authors.initials: MS
authors.lastname: Goodman
mesh_terms: D006801:Humans; D009765:Obesity / Q000208:ethnology*; D015995:Prevalence; D012040:Regional Health Planning; D014481:United States / Q000208:ethnology