“Public health professionals and local decision-makers need access to relevant local-level data about the social determinants of health to improve health outcomes for everyone.”
—Michaela Curran, CDC Foundation
Report Jan-01-2024 3-min read
Table of Contents
Table of Contents
Report Publish Date: January 1, 2024
This report describes a process for assessing how social determinants of health, like access to health care, income, safety, and housing stability, affect the pregnancies who belong to small, hard-to-study populations. These might include pregnant people in a particular county or census tract or belonging to certain racial or ethnic groups or gender identities.
Primary Takeaways
Small area estimation is a statistical method that creates models to estimate the incidence of health-related factors among people in a small geographic area or subpopulation.
The authors say states, counties, and municipalities can use estimates of the social determinants of health in birthing populations made using small area estimation to understand geographic disparities, pinpoint common health issues, create prevention programs, set objectives for improving maternal and child health, and make public health decisions.
Overview and Objectives
Researchers from the CDC and the CDC Foundation wanted to show how small area estimation could be used to better understand what puts smaller groups of birthing people at risk of poor maternal and child health outcomes.
Hypothesis or Approach
The researchers used data from the Pregnancy Risk Assessment Monitoring System, or PRAMS, which collects information on attitudes and experiences before, during, and after pregnancy. They calculated estimates at the state and county level in 40 states and jurisdictions, looking at nine indicators, including postpartum care and depression, intimate partner violence, and problems paying rent. They used a six-step process:
- Select indicators for small area estimation
- Obtain access to the data
- Clean and prepare data
- Estimate models and perform internal validatio
- Develop suppression guidelines
- Release estimates
How This Influences Change
Researchers can use small area estimation to produce reliable estimates of what factors put smaller populations at risk of poor birth outcomes.
Grant Details
Amount awarded:
$2,027,006
Awarded on: 12/17/2021
Timeframe: 2021-2024
Grant number: 79267
Location: Atlanta, GA
About Grantee:
Contact Info
National Foundation for the Centers for Disease Control and Prevention, Inc. Atlanta, GA 30308
www.cdcfoundation.orgResearch: Go Deeper
The social determinants of health are personal (e.g., income), familial (e.g., social support), work-related (e.g., scheduling autonomy), communal (e.g., community cohesion and support) and structural (e.g., federal or state policies) factors that constrain people’s available choices for improving their health.1 Public health professionals and local decision-makers need access to relevant local-level data about the social determinants of health to improve health outcomes for everyone.
Detailed population health surveillance data about pregnancy and childbirth are typically obtained from large-scale survey efforts. However, sample sizes from these survey efforts are often too small to produce reliable direct estimates for lower levels of geographic aggregation (e.g., county, Census tract, etc.) or for subpopulations (e.g., certain racial or ethnic groups, gender identities, etc.) that are small within an area. Small area estimation (SAE) provides a potential solution for producing reliable estimates at lower levels of geographic aggregation or for small subpopulations using a model-based approach.
To help states and jurisdictions gain access to local-level data about maternal and child health, the Centers for Disease Control and Prevention’s (CDC) Division of Reproductive Health team used Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2017-2021) data on attitudes and experiences before, during and shortly after pregnancy to calculate state- and county-level estimates across 40 states and jurisdictions for nine indicators related to the social determinants of health: postpartum visit attendance, postpartum Medicaid insurance status (at the time of survey), postpartum depression as diagnosed by a healthcare provider, intimate partner violence in the 12 months before pregnancy, intimate partner violence during pregnancy, any intimate partner violence (before or during pregnancy), problems paying rent, mortgage or other bills in the 12 months before birth, whether a pregnant person moved in the 12 months before birth and whether a pregnant person was homeless in the 12 months before birth.
This document provides insight into the project’s small area estimation process and offers lessons learned and promising actions for undertaking small area estimation projects. This project was part of the CDC Foundation Improving Engagement in Community Level Data Collection project, which was funded by Robert Wood Johnson. The views expressed here do not necessarily reflect the
views of the Robert Wood Johnson Foundation.
CDC Foundation, January 2024
Research Team
This study and report was conducted and created by the following:
- Michaela Curran
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