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Geospatial risk scoring for a cancer-screening program, and the margin-of-error defect every test missed.

A county cancer-screening program now ranks 70 ZIP areas by where its uninsured, screening-age residents live. Program staff use the ranking to decide where outreach goes.

risk score →area 184 peoplearea 3area 4area 5area 6area 7error bars swamp it
Fig. C2 · ranked estimates with their error bars · schematic
Results

Before and after.

Before
After
No ZIP-level view of the cohort
948,704 residents scored across 70 ZIP areas
Small areas ranked on noise
Rankings account for each estimate’s margin of error
Priority cohort unmeasured
An estimated 7,638 uninsured residents aged 45 to 64, located by ZIP area
The work

How the work went.

The problem

The program needed to know where its uninsured, screening-age residents lived, across a county of nearly a million people. Outreach hours are limited, so the order of the list matters as much as the list.

What we built

We built a scoring service over U.S. Census American Community Survey (ACS) tables with a weighted risk model. Program staff see its output on a map and use it to plan outreach. The final dataset had no missing values, no duplicates and no integrity errors.

The defect every test missed

Every ACS estimate comes with a margin of error. The data-preparation step was dropping those columns, and every test still passed, because the tests checked that the answer looked right. As a result, an area of 84 people ranked second on an estimate its own margin of error swamped. We restored the margins, made the ranking account for them, and now check output against the limits of the source data, not against the answer we expect.

Related

Keep reading.

Questions · Sheet C-12

Questions about this case study.

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How do you account for ACS margin of error when ranking areas?
Keep the margin-of-error columns through every step of the pipeline and make the ranking account for them, so a small area with a noisy estimate cannot outrank areas with reliable ones. Then test the output against what the source data can support.
Why did the tests not catch the defect?
They checked that the answer looked right, and it did. Nothing checked whether the source data could support the answer.

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