Spatio-temporal disease mapping comprises a wide range of models used to describe the distribution of a disease in space and its evolution in time. These models have been commonly formulated within a hierarchical Bayesian framework with two main approaches: an empirical Bayes (EB) and a fully Bayes (FB) approach. The EB approach provides point estimates of the parameters relying on the well-known penalized quasi-likelihood (PQL) technique. The FB approach provides the posterior distribution of the target parameters. These marginal distributions are not usually available in closed form and common estimation procedures are based on Markov chain Monte Carlo (MCMC) methods. However, the spatio-temporal models used in disease mapping are often very complex and MCMC methods may lead to large Monte Carlo errors and a huge computation time if the dimension of the data at hand is large. To circumvent these potential inconveniences, a new technique called integrated nested Laplace approximations (INLA), based on nested Laplace approximations, has been proposed for Bayesian inference in latent Gaussian models. In this paper, we show how to fit different spatio-temporal models for disease mapping with INLA using the Leroux CAR prior for the spatial component, and we compare it with PQL via a simulation study. The spatio-temporal distribution of male brain cancer mortality in Spain during the period 1986-2010 is also analysed.

The purpose of this article is to draw attention to the possible need for inclusion of interaction effects between regions and age groups in mapping studies. We propose a simple model for including such an interaction in order to develop a test for its significance. The assumption of an absence of such interaction effects is a helpful simplifying one. The measure of relative risk related to a particular region becomes easily and neatly summarized. Indeed, such a test seems warranted because it is anticipated that the simple model, which ignores such interaction, as is in common use, may at times be adequate. The test proposed is a score test and hence only requires fitting the simpler model. We illustrate our approaches using mortality data from British Columbia, Canada, over the 5-year period 1985-1989. For this data, the interaction effect between age groups and regions is quite large and significant.

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SUMMARYAnalyzing the temporal evolution of the geographical distribution of mortality (or incidence) risks is an important area of research in disease mapping. It might help to better determining the risk factors involved in the studied disease, and to address important epidemiological questions about the stability of the estimated patterns of disease. Traditionally, risk smoothing is carried out using conditional autoregressive (CAR) models but very recently, penalized splines have also been considered in an Empirical Bayes (EB) spatial context to estimate large-scale spatial trends together with region random effects. In this paper, penalized splines for smoothing risks in both the spatial and the temporal dimensions will be applied. The mean squared error (MSE) of the log-risk predictor will be derived allowing for constructing confidence intervals for the risks. To illustrate the procedure mortality data due to brain cancer in continental Spain over the period 1996-2005 are analyzed.

Disease risk maps for areal unit data are often estimated from Poisson mixed models with local spatial smoothing, for example by incorporating random effects with a conditional autoregressive prior distribution. However, one of the limitations is that local discontinuities in the spatial pattern are not usually modelled, leading to over-smoothing of the risk maps and a masking of clusters of hot/coldspot areas. In this paper, we propose a novel two-stage approach to estimate and map disease risk in the presence of such local discontinuities and clusters. We propose approaches in both spatial and spatio-temporal domains, where for the latter the clusters can either be fixed or allowed to vary over time. In the first stage, we apply an agglomerative hierarchical clustering algorithm to training data to provide sets of potential clusters, and in the second stage, a two-level spatial or spatio-temporal model is applied to each potential cluster configuration. The superiority of the proposed approach with regard to a previous proposal is shown by simulation, and the methodology is applied to two important public health problems in Spain, namely stomach cancer mortality across Spain and brain cancer incidence in the Navarre and Basque Country regions of Spain.