Estimating county-level mortality rates using highly censored data from CDC WONDER

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Introduction CDC WONDER is a system developed to promote informationdriven 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 agestandardized 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.

Original languageEnglish (US)
Article number180441
JournalPreventing Chronic Disease
Issue number6
StatePublished - 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 Centers for Disease Control and Prevention (CDC).


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