Bayesian methods for estimation and mediation in disease mapping applications
Melissa Jay, Gideon K D Zamba, Jacob Oleson, Grant Brown, Joseph Cavanaugh, Mary E. Charlton, Mary Kathryn Cowles · 2022
My dissertation is motivated by the need for improved statistical approaches for understanding differences in cancer risk in rural vs. urban areas. To accomplish this goal, we develop three statistical methods that can be used to model and explain differences in age-adjusted rates between small areas with differing characteristics. These methods allow researchers to draw meaningful inferences from sparse spatial or spatio-temporal datasets at the ZIP code or county levels. Furthermore, they can be used to identify regions that might require public health interventions and to motivate costly data collection efforts at the individual level. The statistical methods we propose in this dissertation can be classified into two categories: estimation and mediation. Chapter 2 focuses on precisely estimating age-adjusted cancer mortality rates for small areas from spatio-temporal datasets with an excessive number of zeros. A large proportion of zeros are often present in datasets involving low-prevalence diseases and in datasets that include rural regions with small population sizes. When stratifying counts for each region and year by age group in the process of estimating age-adjusted rates, the proportion of zeros in the dataset is further inflated. We propose a novel Bayesian hierarchical hurdle model with spatial and temporal random effects for estimating age-adjusted rates in these settings. Via a simulation study and two data examples, we study the performance of this model and make recommendations as to when it should be used over a Bayesian hierarchical Poisson regression model for age-adjusted rates. Chapters 3 and 4 address the goal of mediation. Specifically, Chapter 3 focuses on a method for performing a mediation analysis and Chapter 4 introduces a method for performing a decomposition analysis. Both chapters aim to explain a difference in age-adjusted rates at the ZIP code level based on either a ZIP code-level exposure (mediation) or a fixed characteristic (decomposition). We develop flexible statistical methods that use Bayesian hierarchical models with spatial random effects and a Bayesian version of the g-computation technique from causal inference. Both methods were designed to create counterfactual small area estimates of age-adjusted rates within the analysis and consequently stable estimates of the effects of interest. Through a simulation study, we illustrate a high level of precision and minimal bias in the total, direct, and indirect effects when using our proposed mediation analysis method. We also compare our proposed mediation method to two methods used in the medical literature and show that our method exhibits the best trade-off of bias and variance. To demonstrate the performance of our decomposition method, we perform a data analysis to understand whether park access explains the disparity in age-adjusted colorectal cancer incidence rates in rural vs. urban ZIP codes in Iowa. We illustrate that precise inferences can be made from sparse ZIP code-level datasets when incorporating small area estimation techniques into each analysis.