Checking unimodality using isotonic regression: an application to breast cancer mortality rates

In some diseases it is well-known that a unimodal mortality pattern exists. A clear example in developed countries is breast cancer, where mortality increased sharply until the nineties and then decreased. This clear unimodal pattern is not necessarily applicable to all regions within a country. In this paper, we develop statistical tools to check if the unimodality pattern persists within regions using order restricted inference. Break points as well as confidence intervals are also provided. In addition, a new test for checking monotonicity against unimodality is derived allowing to discriminate between a simple increasing pattern and an up-then-down response pattern. A comparison with the widely used joinpoint regression technique under unimodality is provided. We show that the joinpoint technique could fail when the underlying function is not piecewise linear. Results will be illustrated using age-specific breast cancer mortality data from Spain in the period 1975-2005.This work has been supported by the Spanish Ministry of Science and Innovation (project MTM 2011-22664 jointly sponsored with Feder grants, project MTM 2012-37129 and project MTM2014-51992-R). The work has been also partially supported by the Health Department of Navarre Government (Project 113, Res. 2186/2014)

Bayesian modeling approach in Big Data contexts: an application in spatial epidemiology

In this work we propose a novel scalable Bayesian modeling approach to smooth mortality risks borrowing information from neighbouring regions in high-dimensional spatial disease mapping contexts. The method is based on the well-known divide and conquer approach, so that the spatial domain is divided into D subregions where local spatial models can be fitted simultaneously. Model fitting and inference has been carried out using the integrated nested Laplace approximation (INLA) technique. Male colorectal cancer mortality data in the municipalities of continental Spain have been analyzed using the new model proposals. Results show that the new modeling approach is very competitive in terms of model fitting criteria when compared with a global spatial model, and it is computationally much more efficient.This work has been supported by Project MTM2017-82553-R (AEI/FEDER, UE

Estimating LOCP cancer mortality rates in small domains in Spain using its relationship with lung cancer

The distribution of lip, oral cavity, and pharynx (LOCP) cancer mortality rates in small domains (defined as the combination of province, age group, and gender) remains unknown in Spain. As many of the LOCP risk factors are preventable, specific prevention programmes could be implemented but this requires a clear specification of the target population. This paper provides an in-depth description of LOCP mortality rates by province, age group and gender, giving a complete overview of the disease. This study also presents a methodological challenge. As the number of LOCP cancer cases in small domains (province, age groups and gender) is scarce, univariate spatial models do not provide reliable results or are even impossible to fit. In view of the close link between LOCP and lung cancer, we consider analyzing them jointly by using shared component models. These models allow information-borrowing among diseases, ultimately providing the analysis of cancer sites with few cases at a very disaggregated level. Results show that males have higher mortality rates than females and these rates increase with age. Regions located in the north of Spain show the highest LOCP cancer mortality rates.The work was supported by Project MTM2017-82553-R (AEI, UE), Project PID2020-113125RB-I00/MCIN/ AEI/10.13039/501100011033 and Proyecto Jóvenes Investigadores PJUPNA2018-11