Effect of CDC adjustment of state-reported data on community water fluoridation statistics.
Level 4 - case-series / case-control
Surveillance methodology and data comparison study (by design analogy, not clinical CEBM)
PubMed 37401874 · doi:10.1111/jphd.12579
What was done
The authors evaluated methods used by the Centers for Disease Control and Prevention (CDC) to adjust state-reported community water fluoridation (CWF) data. They compared the percentage deviation of unadjusted state-reported data, 2012-adjusted data, and 2016-adjusted data against reference standard estimates from the U.S. Geological Survey. They also compared CWF coverage statistics and trend estimates calculated by each adjustment method.
What was found
The abstract reports no numerical values or statistical metrics. It states that the 2016 adjustment method outperformed previous methods across all evaluation metrics. The primary national objective measure—the percentage of the population on community water systems receiving fluoridated water—was negligibly affected by the method change, whereas the estimated percentage of the overall U.S. population receiving fluoridated water was lower using the 2016 method compared to the 2012 method.
Why it matters
Validating surveillance adjustment methods ensures public health agencies accurately measure progress toward national oral health goals without confounding real-world trends with methodological changes.
Limits
The abstract reports no quantitative results, sample sizes (such as the number of states, years, or water systems included), or confidence intervals. The evaluation depends on U.S. Geological Survey estimates as a gold standard, which itself may carry estimation error, and findings reflect data processing rather than direct water quality sampling.
Cited by
- partial Approximately 80% of the United States population receives fluoridated municipal water, adding more fluoride to water than the rest of the world combined.