Human Papillomavirus Vaccine Coverage Among Females Aged 11 to 17 in?Texas Counties: An Application of Multilevel, Small Area Estimation

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• 作者：Jan M. Eberth ; PhD^a ; ^{jmeberth@mailbox.sc.edu}Author Vitae ; Md Monir Hossain ; PhD^bAuthor Vitae ; Jasmin A. Tiro ; PhD^cAuthor Vitae ; Xingyou Zhang ; PhD^dAuthor Vitae ; James B. Holt ; PhD^dAuthor Vitae ; Sally W. Vernon ; PhD^eAuthor Vitae
• 刊名：Women's Health Issues
• 出版年：2013
• 出版时间：March-April, 2013
• 年：2013
• 卷：23
• 期：2
• 页码：e131-e141
• 全文大小：815 K

文摘

Background

Local data are often used to plan and evaluate public health interventions and policy. With increasingly fewer public resources to collect sufficient data to support direct estimation of local outcomes, methods for deriving small area estimates are vital. The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among adolescent females in Texas using multilevel small area estimation.

Methods

Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (¡Ý1 dose Gardasil) from the 2008 Behavioral Risk Factor Surveillance System. Using the parameter estimates from the final model, we simulated 10,000 data sets 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 coverage estimates ranged from 7 % to 29 % , compared with the state average of 18 % (95 % confidence interval [CI], 13.59-21.88). Many Southwestern border and metropolitan counties exhibited high coverage estimates. Low coverage estimates were noted in the Panhandle, Southeastern border region, and Northeast. Significant correlations were observed between HPV vaccination and Hispanic ethnicity, county poverty, and public health region poverty.

Conclusion

Harnessing the flexibility of multilevel small area models to estimate HPV vaccine coverage at the county level, we have provided data that may inform the development of health education programs/policies, the provision of health services, and the planning of new research studies. Additionally, we have provided a framework for modeling other health outcomes at the county level using national survey data.