State-level estimation of diabetes and prediabetes prevalence: Combining national and local survey data and clinical data

Stat Med. 2018 Nov 30;37(27):3975-3990. doi: 10.1002/sim.7848. Epub 2018 Jun 22.


Many statisticians and policy researchers are interested in using data generated through the normal delivery of health care services, rather than carefully designed and implemented population-representative surveys, to estimate disease prevalence. These larger databases allow for the estimation of smaller geographies, for example, states, at potentially lower expense. However, these health care records frequently do not cover all of the population of interest and may not collect some covariates that are important for accurate estimation. In a recent paper, the authors have described how to adjust for the incomplete coverage of administrative claims data and electronic health records at the state or local level. This article illustrates how to adjust and combine multiple data sets, namely, national surveys, state-level surveys, claims data, and electronic health record data, to improve estimates of diabetes and prediabetes prevalence, along with the estimates of the method's accuracy. We demonstrate and validate the method using data from three jurisdictions (Alabama, California, and New York City). This method can be applied more generally to other areas and other data sources.

Keywords: HRS; MarketScan; NAMCS; NHANES; big data; composite estimation; diabetes; prediabetes.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Bias
  • California / epidemiology
  • Diabetes Mellitus / epidemiology*
  • Electronic Health Records / statistics & numerical data
  • Health Surveys
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • New York City / epidemiology
  • Nutrition Surveys / statistics & numerical data
  • Prediabetic State / epidemiology*
  • Prevalence
  • Statistics as Topic*
  • United States / epidemiology