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The reliability of the American Community Survey for injury surveillance
  1. Nathaniel Bell1,2,3,
  2. Bo Cai2
  1. 1College of Nursing, University of South Carolina, Columbia, South Carolina, USA
  2. 2Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  3. 3Department of Surgery, University of South Carolina, Columbia, South Carolina, USA
  1. Correspondence to Professor Nathaniel Bell, College of Nursing, University of South Carolina, 1601 Greene St., Columbia, SC 29208, USA; nathaniel{at}


Background To evaluate the reliability and predictability of 49 socioeconomic indicators constructed from the annual and multiyear American Community Survey (ACS) data cycles for monitoring injury inequalities across the USA.

Methods Cross-sectional analysis of the 2006–2013 annual and multiyear county-level ACS data cycles. Indicator reliability was assessed using the margin of error and coefficient of variation (CV). Overlapping multiyear data cycles were assessed for statistical dependence in the estimates. Negative binomial regression models were constructed from a selection of the most reliable indicators over time and across all data cycles using all-cause unintentional and homicide-related mortality records from the National Center for Health Statistics (NCHS).

Results Fewer than half of all indicators for each data cycle generated ‘high reliability’ CV estimates for at least 95% of all census counties. Indicator reliability did not linearly improve with increasing sample size afforded from the multiyear surveys. On average, changes in socioeconomic conditions for the same geographic areas were statistically significantly different (p<0.05) in 14% (rage 0–99%) to 16% (rage 0–93%) of all overlapping multiyear data cycles. ACS indicators that were among the most reliable across data cycles corroborated variable relationships derived using estimates from the 2000 decennial census and corresponding NCHS records for that year.

Conclusions Few of the socioeconomic indicators previously used to measure injury disparities are consistently reliable across all ACS data cycles. Researchers should be judicious when selecting consecutive multiyear data cycles to approximate changes in annual socioeconomic conditions. Among the indicators that are reliable, it is advisable to use estimates from the annual ACS data cycle as a crude barometer of injury inequalities and the multiyear files to confirm and add precedence to national trends every three and five years.

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  • Contributors Study concept and design, and acquisition of data: NB. Statistical analysis and interpretation of the data, drafting of the manuscript, and Review and critique of final manuscript draft: NB and BC. Both authors have given final approval of the manuscript.

  • Funding University of South Carolina (Social Sciences Research Grant).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data to reconstruct findings from this study are in the public domain and can be requested from the NCHS.