107,169 research outputs found

    Joint disease mapping using six cancers in the Yorkshire region of England

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    OBJECTIVES: The aims of this study were to model jointly the incidence rates of six smoking related cancers in the Yorkshire region of England, to explore the patterns of spatial correlation amongst them, and to estimate the relative weight of smoking and other shared risk factors for the relevant disease sites, both before and after adjustment for socioeconomic background (SEB). METHODS: Data on the incidence of oesophagus, stomach, pancreas, lung, kidney, and bladder cancers between 1983 and 2003 were extracted from the Northern & Yorkshire Cancer Registry database for the 532 electoral wards in the Yorkshire region. Using postcode of residence, each case was assigned an area-based measure of SEB using the Townsend index. Standardised incidence ratios (SIRs) were calculated for each cancer site and their correlations investigated. The joint analysis of the spatial variation in incidence used a Bayesian shared-component model. Three components were included to represent differences in smoking (for all six sites), bodyweight/obesity (for oesophagus, pancreas and kidney cancers) and diet/alcohol consumption (for oesophagus and stomach cancers). RESULTS: The incidence of cancers of the oesophagus, pancreas, kidney, and bladder was relatively evenly distributed across the region. The incidence of stomach and lung cancers was more clustered around the urban areas in the south of the region, and these two cancers were significantly associated with higher levels of area deprivation. The incidence of lung cancer was most impacted by adjustment for SEB, with the rural/urban split becoming less apparent. The component representing smoking had a larger effect on cancer incidence in the eastern part of the region. The effects of the other two components were small and disappeared after adjustment for SEB. CONCLUSIONS: This study demonstrates the feasibility of joint disease modelling using data from six cancer sites. Incidence estimates are more precise than those obtained without smoothing. This methodology may be an important tool to help authorities evaluate healthcare system performance and the impact of policies

    A space-time conditional intensity model for infectious disease occurence

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    A novel point process model continuous in space-time is proposed for infectious disease data. Modelling is based on the conditional intensity function (CIF) and extends an additive-multiplicative CIF model previously proposed for discrete space epidemic modelling. Estimation is performed by means of full maximum likelihood and a simulation algorithm is presented. The particular application of interest is the stochastic modelling of the transmission dynamics of the two most common meningococcal antigenic sequence types observed in Germany 2002–2008. Altogether, the proposed methodology represents a comprehensive and universal regression framework for the modelling, simulation and inference of self-exciting spatio-temporal point processes based on the CIF. Application is promoted by an implementation in the R package RLadyBug

    Multivariate space-time modelling of multiple air pollutants and their health effects accounting for exposure uncertainty

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    The long-term health effects of air pollution are often estimated using a spatio-temporal ecological areal unit study, but this design leads to the following statistical challenges: (1) how to estimate spatially representative pollution concentrations for each areal unit; (2) how to allow for the uncertainty in these estimated concentrations when estimating their health effects; and (3) how to simultaneously estimate the joint effects of multiple correlated pollutants. This article proposes a novel 2-stage Bayesian hierarchical model for addressing these 3 challenges, with inference based on Markov chain Monte Carlo simulation. The first stage is a multivariate spatio-temporal fusion model for predicting areal level average concentrations of multiple pollutants from both monitored and modelled pollution data. The second stage is a spatio-temporal model for estimating the health impact of multiple correlated pollutants simultaneously, which accounts for the uncertainty in the estimated pollution concentrations. The novel methodology is motivated by a new study of the impact of both particulate matter and nitrogen dioxide concentrations on respiratory hospital admissions in Scotland between 2007 and 2011, and the results suggest that both pollutants exhibit substantial and independent health effects

    Bayesian joint spatio-temporal analysis of multiple diseases

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    In this paper we propose a Bayesian hierarchical spatio-temporal model for the joint analysis of multiple diseases which includes specific and shared spatial and temporal effects. Dependence on shared terms is controlled by disease-specific weights so that their posterior distribution can be used to identify diseases with similar spatial and temporal patterns. The model proposed here has been used to study three different causes of death (oral cavity, esophagus and stomach cancer) in Spain at the province level. Shared and specific spatial and temporal effects have been estimated and mapped in order to study similarities and differences among these causes. Furthermore, estimates using Markov chain Monte Carlo and the integrated nested Laplace approximation are compared.Peer Reviewe

    Spatio-temporal epidemic modelling using additive-multiplicative intensity models

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    An extension of the stochastic susceptible-infectious-recovered (SIR) model is proposed in order to accommodate a regression context for modelling infectious disease surveillance data. The proposal is based on a multivariate counting process specified by conditional intensities, which contain an additive epidemic component and a multiplicative endemic component. This allows the analysis of endemic infectious diseases by quantifying risk factors for infection by external sources in addition to infective contacts. Simulation from the model is straightforward by Ogata's modified thinning algorithm. Inference can be performed by considering the full likelihood of the stochastic process with additional parameter restrictions to ensure non-negative conditional intensities. As an illustration we analyse data provided by the Federal Research Centre for Virus Diseases of Animals, Wusterhausen, Germany, on the incidence of the classical swine fever virus in Germany during 1993-2004

    A space-time multivariate Bayesian model to analyse road traffic accidents by severity

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    The paper investigates the dependences between levels of severity of road traffic accidents, accounting at the same time for spatial and temporal correlations. The study analyses road traffic accidents data at ward level in England over the period 2005–2013. We include in our model multivariate spatially structured and unstructured effects to capture the dependences between severities, within a Bayesian hierarchical formulation. We also include a temporal component to capture the time effects and we carry out an extensive model comparison. The results show important associations in both spatially structured and unstructured effects between severities, and a downward temporal trend is observed for low and high levels of severity. Maps of posterior accident rates indicate elevated risk within big cities for accidents of low severity and in suburban areas in the north and on the southern coast of England for accidents of high severity. The posterior probability of extreme rates is used to suggest the presence of hot spots in a public health perspective.Areti Boulieri acknowledges support from the National Institute for Health Research and the Medical Research Council Doctoral Training Partnership. Marta Blangiardo acknowledges support from the National Institute for Health Research and the Medical Research Council–Public Health England Centre for Environment and Health. Silvia Liverani acknowledges support from the Leverhulme Trust (grant ECF-2011-576)

    Cluster detection and risk estimation for spatio-temporal health data

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    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

    Stochastic modelling of the spatial spread of influenza in Germany

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    In geographical epidemiology, disease counts are typically available in discrete spatial units and at discrete time-points. For example, surveillance data on infectious diseases usually consists of weekly counts of new infections in pre-defined geographical areas. Similarly, but on a different time-scale, cancer registries typically report yearly incidence or mortality counts in administrative regions. A major methodological challenge lies in building realistic models for space-time interactions on discrete irregular spatial graphs. In this paper, we will discuss an observation-driven approach, where past observed counts in neighbouring areas enter directly as explanatory variables, in contrast to the parameter-driven approach through latent Gaussian Markov random fields (Rue and Held, 2005) with spatio-temporal structure. The main focus will lie on the demonstration of the spread of influenza in Germany, obtained through the design and simulation of a spatial extension of the classical SIR model (Hufnagel et al., 2004)

    Using geographically weighted regression to explore the spatially heterogeneous spread of bovine tuberculosis in England and Wales

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    An understanding of the factors that affect the spread of endemic bovine tuberculosis (bTB) is critical for the development of measures to stop and reverse this spread. Analyses of spatial data need to account for the inherent spatial heterogeneity within the data, or else spatial autocorrelation can lead to an overestimate of the significance of variables. This study used three methods of analysis—least-squares linear regression with a spatial autocorrelation term, geographically weighted regression (GWR) and boosted regression tree (BRT) analysis—to identify the factors that influence the spread of endemic bTB at a local level in England and Wales. The linear regression and GWR methods demonstrated the importance of accounting for spatial differences in risk factors for bTB, and showed some consistency in the identification of certain factors related to flooding, disease history and the presence of multiple genotypes of bTB. This is the first attempt to explore the factors associated with the spread of endemic bTB in England and Wales using GWR. This technique improves on least-squares linear regression approaches by identifying regional differences in the factors associated with bTB spread. However, interpretation of these complex regional differences is difficult and the approach does not lend itself to predictive models which are likely to be of more value to policy makers. Methods such as BRT may be more suited to such a task. Here we have demonstrated that GWR and BRT can produce comparable outputs
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