Methodology

The method of generating small area estimation (SAE) of the measures is a multi-level statistical modeling framework.
Specifically, CDC will use an innovative peer-reviewed multi-level regression and poststratification (MRP) approach that links geocoded health surveys and high spatial resolution population demographic and socioeconomic data.
The approach also accounts for the associations between individual health outcomes, individual characteristics, and spatial contexts and factors at multiple levels (e.g., state, county); predicts individual disease risk and health behaviors in a multi-level modeling framework, and estimates the geographic distributions of population disease burden and health behaviors.
The MRP approach is flexible and will help CDC provide modeled estimates of the prevalence for each indicator at the census tract and city levels.
Small area estimates using this MRP approach have been published using data from CDC’s Behavioral Risk Factor Surveillance System (BRFSS) and the National Survey of Children’s Health.
CDC’s internal and external validation studies confirm the strong consistency between MRP model-based SAEs and direct BRFSS survey estimates at both state and county levels.
The primary data sources for this project are the CDC Behavioral Risk Factor Surveillance System, the Census 2010 population, and the American Community Survey estimates.

Further information on the small area estimation methodology can be obtained from:

The 27 measures include 5 unhealthy behaviors, 13 health outcomes, and 9 prevention practices.
The measures include major risk behaviors that lead to illness, suffering, and early death related to chronic diseases and conditions, as well as the conditions and diseases that are the most common, costly, and preventable of all health problems.
Each measure will have a comprehensive definition that includes the background, significance, limitations of the indicator, data source, and limitations of the data resources.
Measures will complement existing sets of surveillance indicators that report state, metropolitan area, and county-level data, including County Health Rankings, Chronic Disease Indicators, and Community Health Status Indicators.

Arthritis among adults aged ≥18 years
Current asthma among adults aged ≥18 years
High blood pressure among adults aged ≥18 years
Cancer (excluding skin cancer) among adults aged ≥18 years
High cholesterol among adults aged ≥18 years who have been screened in the past 5 years
Chronic kidney disease among adults aged ≥18 years
Chronic obstructive pulmonary disease among adults aged ≥18 years
Coronary heart disease among adults aged ≥18 years
Diagnosed diabetes among adults aged ≥18 years
Mental health not good for ≥14 days among adults aged ≥18 years
Physical health not good for ≥14 days among adults aged ≥18 years
All teeth lost among adults aged ≥65 years
Stroke among adults aged ≥18 years

Current lack of health insurance among adults aged 18-64 years
Visits to doctor for routine checkup within the past year among adults aged ≥18 years
Visits to dentist or dental clinic among adults aged ≥18 years
Taking medicine for high blood pressure control among adults aged ≥18 years with high blood pressure
Cholesterol screening among adults aged ≥18 years
Mammography use among women aged 50-74 years
Papanicolaou smear use among adult women aged 21-65 years
Fecal occult blood test, sigmoidoscopy, or colonoscopy among adults aged 50-75 years
Older adults aged ≥65 years who are up to date on a core set of clinical preventive services (Men: Flu shot past year, Pneumococcal polysaccharides vaccine (PPV) shot ever, Colorectal cancer screening; Women: Same as above, and Mammogram past 2 years)

Cities:

The project will deliver data for the 497 largest American cities and will include data from the largest cities in Vermont (Burlington – population: 42,417), West Virginia (Charleston – population: 51,400) and Wyoming (Cheyenne – population: 59,466) to ensure inclusion of cities from all the states; bringing the total to 500 cities.
The number of cities per state ranges from 1 to 121.
The cities range in population from 42,417 in Burlington, Vermont to 8,175,133 in New York City, New York.
Among these 500 cities, there are approximately 28,000 census tracts, for which data will be provided. The tracts range in population from less than 50 to 28,960, and in size from less than 1 square mile to more than 642 square miles. The number of tracts per city ranges from 8 to 2,140.
The project includes a total population of 103,020,808, which represents 33.4% of the total United States population of 308,745,538.
Largest 500 US Cities Map[PDF-314KB](https://www.cdc.gov/500cities/pdf/500-cities-listed-by-state.pdf)