Beta-binomial regression and bimodal utilization
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Updated: May 13, 2026

Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
Chuan-Fen Liu1, James F Burgess, Willard G Manning
1Northwest Center for Outcomes Research in Older Adults at the VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108.
Objective:
To illustrate how the analysis of bimodal U-shaped distributed utilization can be modeled with beta-binomial regression, which is rarely used in health services research.
Data Sources/Study Setting:
Veterans Affairs (VA) administrative data and Medicare claims in 2001-2004 for 11,123 Medicare-eligible VA primary care users in 2000.
Study Design:
We compared means and distributions of VA reliance (the proportion of all VA/Medicare primary care visits occurring in VA) predicted from beta-binomial, binomial, and ordinary least-squares (OLS) models.
Principal Findings:
Beta-binomial model fits the bimodal distribution of VA reliance better than binomial and OLS models due to the nondependence on normality and the greater flexibility in shape parameters.
Conclusions:
Increased awareness of beta-binomial regression may help analysts apply appropriate methods to outcomes with bimodal or U-shaped distributions.
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