Geographically Weighted Surrogate Models for Rapid Small-Area Chronic Disease Estimation

Small-area estimation (SAE) enables researchers and policymakers to identify spatial disparities in health outcomes, but survey-based SAE products carry an inherent lag. Gold-standard estimates such as CDC PLACES are released roughly two years after the underlying survey data are collected, limiting their use for time-sensitive decision-making. This study evaluates the potential for machine learning (ML) to serve as a surrogate, learning the relationship between frequently updated area-level predictors and existing SAE outputs to generate timely, comparable estimates in years when SAE from surveys are unavailable or delayed. We evaluate several global and geographically weighted ML models for county-level SAE of ten chronic conditions across the US: COPD, asthma, heart disease, arthritis, cancer, depression, diabetes, high blood pressure, high cholesterol, and stroke. Our findings suggest that geographically weighted ML frameworks like geographically weighted random forest and geographically weighted regression offer scalable and open data surrogates for rapidly generating SAE and supporting data driven decision making.