Cluster detection and risk estimation for spatio-temporal health data

In epidemiological disease mapping one aims to estimate the spatio-temporal pattern in disease risk and identify high-risk clusters, allowing health interventions to be appropriately targeted. Bayesian spatio-temporal models are used to estimate smoothed risk surfaces, but this is contrary to the aim of identifying groups of areal units that exhibit elevated risks compared with their neighbours. Therefore, in this paper we propose a new Bayesian hierarchical modelling approach for simultaneously estimating disease risk and identifying high-risk clusters in space and time. Inference for this model is based on Markov chain Monte Carlo simulation, using the freely available R package CARBayesST that has been developed in conjunction with this paper. Our methodology is motivated by two case studies, the first of which assesses if there is a relationship between Public health Districts and colon cancer clusters in Georgia, while the second looks at the impact of the smoking ban in public places in England on cardiovascular disease clusters

Spatial clustering of average risks and risk trends in Bayesian disease mapping

Spatiotemporal disease mapping focuses on estimating the spatial pattern in disease risk across a set of nonoverlapping areal units over a fixed period of time. The key aim of such research is to identify areas that have a high average level of disease risk or where disease risk is increasing over time, thus allowing public health interventions to be focused on these areas. Such aims are well suited to the statistical approach of clustering, and while much research has been done in this area in a purely spatial setting, only a handful of approaches have focused on spatiotemporal clustering of disease risk. Therefore, this paper outlines a new modeling approach for clustering spatiotemporal disease risk data, by clustering areas based on both their mean risk levels and the behavior of their temporal trends. The efficacy of the methodology is established by a simulation study, and is illustrated by a study of respiratory disease risk in Glasgow, Scotland

Effect fusion using model-based clustering

In social and economic studies many of the collected variables are measured on a nominal scale, often with a large number of categories. The definition of categories is usually not unambiguous and different classification schemes using either a finer or a coarser grid are possible. Categorisation has an impact when such a variable is included as covariate in a regression model: a too fine grid will result in imprecise estimates of the corresponding effects, whereas with a too coarse grid important effects will be missed, resulting in biased effect estimates and poor predictive performance. To achieve automatic grouping of levels with essentially the same effect, we adopt a Bayesian approach and specify the prior on the level effects as a location mixture of spiky normal components. Fusion of level effects is induced by a prior on the mixture weights which encourages empty components. Model-based clustering of the effects during MCMC sampling allows to simultaneously detect categories which have essentially the same effect size and identify variables with no effect at all. The properties of this approach are investigated in simulation studies. Finally, the method is applied to analyse effects of high-dimensional categorical predictors on income in Austria

A semi-parametric approach to estimate risk functions associated with multi-dimensional exposure profiles: application to smoking and lung cancer

A common characteristic of environmental epidemiology is the multi-dimensional aspect of exposure patterns, frequently reduced to a cumulative exposure for simplicity of analysis. By adopting a flexible Bayesian clustering approach, we explore the risk function linking exposure history to disease. This approach is applied here to study the relationship between different smoking characteristics and lung cancer in the framework of a population based case control study