Comparison of Census Tract-Level Chronic Disease Prevalence Estimates From 500 Cities and Local Health Claims Data.

Abstract

Objectives: To compare city and census tract-level diabetes and hypertension prevalence using 500 Cities Project modeled estimates from the Centers for Disease Control and Prevention (CDC) and insurance claims data.

Methods: Insurance claims by census tract were collected from 3 local health plans for the city of Pittsburgh, Pennsylvania, for 2015-2016; conditions were defined using International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes. Crude prevalence estimates with 95% confidence intervals were downloaded from the CDC 500 Cities Web site to obtain modeled estimates by census tract. Confidence intervals were calculated for claims and compared with modeled estimates; nonoverlapping intervals were considered significant. Pearson correlation coefficients were generated for census tract-level comparison.

Results: City-level model-based and claims estimates were 9% versus 10% for diabetes and 31% versus 21% for hypertension. At the census tract level, model-based and insurance claims estimates were more concordant for diabetes (r = 0.366) than for hypertension (r = 0.220). Modeled estimates were significantly higher than claims estimates for 89% of census tracts for hypertension and 35% for diabetes.

Conclusions: Modeled estimates from the 500 Cites Project were significantly higher than insurance claims estimates for hypertension but were more consistent for diabetes. Utilization of multiple data sources to understand local-level chronic disease burden requires consideration of the strengths and limitations of each.