Ranking composite Cancer Burden Indices for geographic regions: point and interval estimates

Bin Huang, Elizabeth Pollock, Li Zhu, Jessica P. Athens, Ron Gangnon, Eric J. Feuer, Thomas C. Tucker

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: To develop a composite Cancer Burden Index and produce 95% confidence intervals (CIs) as measures of uncertainties for the index. Methods: The Kentucky Cancer Registry has developed a cancer burden Rank Sum Index (RSI) to guide statewide comprehensive cancer control activities. However, lack of interval estimates for RSI limits its applications. RSI also weights individual measures with little inherent variability equally as ones with large variability. To address these issues, a Modified Sum Index (MSI) was developed to take into account of magnitudes of observed values. A simulation approach was used to generate individual and simultaneous 95% CIs for the rank MSI. An uncertainty measure was also calculated. Results: At the Area Development Districts (ADDs) level, the ranks of the RSI and the MSI were almost identical, while larger variation was found at the county level. The widths of the CIs at the ADD level were considerably shorter than those at the county level. Conclusion: The measures developed for estimating composite cancer burden indices and the simulated CIs provide valuable information to guide cancer prevention and control effort. Caution should be taken when interpreting ranks from small population geographic units where the CIs for the ranks overlap considerably.

Original languageEnglish
Pages (from-to)279-287
Number of pages9
JournalCancer Causes and Control
Issue number2
StatePublished - Feb 1 2018

Bibliographical note

Publisher Copyright:
© 2018, Springer International Publishing AG, part of Springer Nature.


  • Cancer Burden Index
  • Cancer prevention and control
  • Rank Sum Index
  • Simultaneous confidence interval
  • Small geographic area
  • Uncertainty measures

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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