Disease mapping is the field of spatial epidemiology interested in estimating the spatial pattern in disease risk across [Formula: see text] areal units. One aim is to identify units exhibiting elevated disease risks, so that public health interventions can be made. Bayesian hierarchical models with a spatially smooth conditional autoregressive prior are used for this purpose, but they cannot identify the spatial extent of high-risk clusters. Therefore, we propose a two-stage solution to this problem, with the first stage being a spatially adjusted hierarchical agglomerative clustering algorithm. This algorithm is applied to data prior to the study period, and produces [Formula: see text] potential cluster structures for the disease data. The second stage fits a separate Poisson log-linear model to the study data for each cluster structure, which allows for step-changes in risk where two clusters meet. The most appropriate cluster structure is chosen by model comparison techniques, specifically by minimizing the Deviance Information Criterion. The efficacy of the methodology is established by a simulation study, and is illustrated by a study of respiratory disease risk in Glasgow, Scotland.
The field of spatio-temporal modelling has witnessed a recent surge as a result of developments in computational power and increased data collection. These developments allow analysts to model the evolution of health outcomes in both space and time simultaneously. This paper models the trends in ischaemic heart disease (IHD) in New South Wales, Australia over an eight-year period between 2006 and 2013. A number of spatio-temporal models are considered, and we propose a novel method for determining the goodness-of-fit for these models by outlining a spatio-temporal extension of the Moran’s I statistic. We identify an overall decrease in the rates of IHD, but note that the extent of this health improvement varies across the state. In particular, we identified a number of remote areas in the north and west of the state where the risk stayed constant or even increased slightly.
The Bill and Melinda Gates Foundation's Healthy Birth, Growth and Development knowledge integration project aims to improve the overall health and well-being of children across the world. The project aims to integrate information from multiple child growth studies to allow health professionals and policy makers to make informed decisions about interventions in lower and middle income countries. To achieve this goal, we must first understand the conditions that impact on the growth and development of children, and this requires sensible models for characterising different growth patterns. The contribution of this paper is to provide a quantitative comparison of the predictive abilities of various statistical growth modelling techniques based on a novel leave-one-out validation approach. The majority of existing studies have used raw growth data for modelling, but we show that fitting models to standardised data provide more accurate estimation and prediction. Our work is illustrated with an example from a study into child development in a middle income country in South America.
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