Open Access
Online relative risks/rates estimation in spatial and spatio-temporal disease mapping
(Elsevier, 2019) Adin Urtasun, Aritz; Goicoa Mangado, Tomás; Ugarte Martínez, María Dolores; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2; Estadística, Informática y Matemáticas
Background and objective: Spatial and spatio-temporal analyses of count data are crucial in epidemiology and other fields to unveil spatial and spatio-temporal patterns of incidence and/or mortality risks. However, fitting spatial and spatio-temporal models is not easy for non-expert users. The objective of this paper is to present an interactive and user-friendly web application (named SSTCDapp) for the analysis of spatial and spatio-temporal mortality or incidence data. Although SSTCDapp is simple to use, the underlying statistical theory is well founded and all key issues such as model identifiability, model selection, and several spatial priors and hyperpriors for sensitivity analyses are properly addressed. Methods: The web application is designed to fit an extensive range of fairly complex spatio-temporal models to smooth the very often extremely variable standardized incidence/mortality risks or crude rates. The application is built with the R package shiny and relies on the well founded integrated nested Laplace approximation technique for model fitting and inference. Results: The use of the web application is shown through the analysis of Spanish spatio-temporal breast cancer data. Different possibilities for the analysis regarding the type of model, model selection criteria, and a range of graphical as well as numerical outputs are provided. Conclusions: Unlike other software used in disease mapping, SSTCDapp facilitates the fit of complex statistical models to non-experts users without the need of installing any software in their own computers, since all the analyses and computations are made in a powerful remote server. In addition, a desktop version is also available to run the application locally in those cases in which data confidentiality is a serious issue.
Open Access
Hierarchical and spline-based models in space-time disease mapping
(2017) Adin Urtasun, Aritz; Ugarte Martínez, María Dolores; Goicoa Mangado, Tomás; Estadística e Investigación Operativa; Estatistika eta Ikerketa Operatiboa
La representación cartográfica de enfermedades (disease mapping) es un área de investigación de gran interés en epidemiología y salud pública. La gran variabilidad inherente a las medidas clásicas de estimación de riesgo como la razón de mortalidad estandarizada, hacen necesario el uso de técnicas estadísticas que estabilicen estas razones. Durante los últimos años se han desarrollado muchos modelos estadísticos para estudiar la distribución geográfica de una enfermedad y su evolución en el tiempo. Sin embargo, la disponibilidad de datos de alta calidad recogidos en muchas regiones y durante largos periodos de tiempo, así como la aparición de nuevos y cada vez más sofisticados modelos, han revelado nuevas dificultades que necesitan ser investigadas a fondo. En el Capítulo 1 se describen algunos modelos espacio-temporales de relevancia para el resto de capítulos abordados en la tesis y se detallan las restricciones necesarias para resolver los problemas de identificación de dichos modelos. El Capítulo 1 también describe la técnica inferencia! Bayesiana utilizada a lo largo de la tesis, basada en aproximaciones de Laplace e integración numérica (conocida como INLA), y su implementación en R. En el Capítulo 2 se han comparado cinco modelos espacio-temporales utilizados en disease mapping. Para poder comparar los diferentes términos de estos modelos, se ha calculado una descomposición del logaritmo de los riesgos estimados definiendo patrones espaciales, temporales y espacio-temporales a posteriori. Los resultados se ilustran con datos de mortalidad por cáncer de encéfalo en las provincias Españolas durante el periodo 1986-2010. Además, se ha realizado un estudio de simulación para comparar el rendimiento de los modelos en términos de sensitividad (habilidad para detectar regiones de alto riesgo verdaderas) y especificidad (habilidad para descartar regiones de alto riesgo falsas). Se concluye que cuando el número de casos esperados es muy pequeño (algo común cuando se analizan enfermedades raras o dominios muy pequeños como municipios), los modelos de P-splines se comportan mejor en términos de detección de áreas de alto riesgo. En el Capítulo 3 se propone una nueva familia de modelos espacio-temporales que incluyen efectos aleatorios para dos niveles espaciales, permitiendo modelizar efectos espaciales y espacio-temporales a diferentes niveles de agregación (como por ejemplo, municipios dentro de provincias o zonas de salud que se ven afectados por políticas de salud similares). Estos modelos han sido utilizados para analizar los datos de mortalidad en los municipios del País Vasco y Navarra durante el periodo 1986-2008. Se ha realizado un estudio de simulación en donde se concluye que si existen diferentes niveles de agregación espacial, los nuevos modelos a dos niveles se comportan mejor que modelos previos propuestos en la literatura. En el Capítulo 4 se presentan nuevos modelos de E-splines que incluyen correlaciones espaciales y temporales desde un enfoque completamente Bayesiano. Concretamente se describen modelos que incluyen B-spline temporales unidimensionales que pueden tener (o no) correlación espacial, así como modelos de B-spline espaciales bidimensionales que pueden tener (o no) correlación temporal. Los resultados se ilustran con datos de mortalidad por cáncer de mama en la España peninsular durante el periodo 1990-2010. Se observa que, en general, utilizar modelos con B-spline temporales distintos para cada área proporciona mejores resultados en términos de ajuste. Sin embargo, cuando el número de áreas aumenta, estos modelos pueden no ser factibles desde un punto de vista computacional. Por el contrario, los modelos de P-spline tridimensionales (previamente propuestos en la literatura y formulados en esta tesis desde un punto de vista completamente Bayesiano) son una alternativa prometedora, obteniendo estimaciones del riesgo precisas en tiempos computaciones mucho más cortos.
Open Access
A two-stage approach to estimate spatial and spatio-temporal disease risks in the presence of local discontinuities and clusters
(SAGE, 2018-04-13) Adin Urtasun, Aritz; Lee, Duncan; Goicoa Mangado, Tomás; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
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.
Open Access
Flexible Bayesian P-splines for smoothing age-specific spatio-temporal mortality patterns
(SAGE, 2019) Goicoa Mangado, Tomás; Adin Urtasun, Aritz; Etxeberria Andueza, Jaione; Militino, Ana F.; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
In this paper age-space-time models based on one and two-dimensional P-splines with B-spline bases are proposed for smoothing mortality rates, where both xed relative scale and scale invariant two-dimensional penalties are examined. Model tting and inference are carried out using integrated nested Laplace approximations (INLA), a recent Bayesian technique that speeds up computations compared to McMC methods. The models will be illustrated with Spanish breast cancer mortality data during the period 1985-2010, where a general decline in breast cancer mortality has been observed in Spanish provinces in the last decades. The results reveal that mortality rates for the oldest age groups do not decrease in all provinces.
Open Access
Identifying extreme COVID-19 mortality risks in English small areas: a disease cluster approach
(Springer, 2022) Adin Urtasun, Aritz; Congdon, P.; Santafé Rodrigo, Guzmán; Ugarte Martínez, María Dolores; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2; Estadística, Informática y Matemáticas
The COVID-19 pandemic is having a huge impact worldwide and has highlighted the extent of health inequalities between countries but also in small areas within a country. Identifying areas with high mortality is important both of public health mitigation in COVID-19 outbreaks, and of longer term efforts to tackle social inequalities in health. In this paper we consider different statistical models and an extension of a recent method to analyze COVID-19 related mortality in English small areas during the first wave of the epidemic in the first half of 2020. We seek to identify hotspots, and where they are most geographically concentrated, taking account of observed area factors as well as spatial correlation and clustering in regression residuals, while also allowing for spatial discontinuities. Results show an excess of COVID-19 mortality cases in small areas surrounding London and in other small areas in North-East and and North-West of England. Models alleviating spatial confounding show ethnic isolation, air quality and area morbidity covariates having a significant and broadly similar impact on COVID-19 mortality, whereas nursing home location seems to be slightly less important.
Open Access
Space-time analysis of ovarian cancer mortality rates by age groups in Spanish provinces (1989-2015)
(BioMed Central, 2020) Trandafir, Paula Camelia; Adin Urtasun, Aritz; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
Background: Ovarian cancer is a silent and largely asymptomatic cancer, leading to late diagnosis and worse prognosis. The late-stage detection and low survival rates, makes the study of the space-time evolution of ovarian cancer particularly relevant. In addition, research of this cancer in small areas (like provinces or counties) is still scarce. Methods: The study presented here covers all ovarian cancer deaths for women over 50 years of age in the provinces of Spain during the period 1989-2015. Spatio-temporal models have been fitted to smooth ovarian cancer mortality rates in age groups [50,60), [60,70), [70,80), and [80,+), borrowing information from spatial and temporal neighbours. Model fitting and inference has been carried out using the Integrated Nested Laplace Approximation (INLA) technique. Results: Large differences in ovarian cancer mortality among the age groups have been found, with higher mortality rates in the older age groups. Striking differences are observed between northern and southern Spain. The global temporal trends (by age group) reveal that the evolution of ovarian cancer over the whole of Spain has remained nearly constant since the early 2000s. Conclusion: Differences in ovarian cancer mortality exist among the Spanish provinces, years, and age groups. As the exact causes of ovarian cancer remain unknown, spatio-temporal analyses by age groups are essential to discover inequalities in ovarian cancer mortality. Women over 60 years of age should be the focus of follow-up studies as the mortality rates remain constant since 2002. High-mortality provinces should also be monitored to look for specific risk factors.
Open Access
Dealing with risk discontinuities to estimate cancer mortality risks when the number of small areas is large
(SAGE, 2021-02-17) Santafé Rodrigo, Guzmán; Adin Urtasun, Aritz; Lee, Duncan; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
Many statistical models have been developed during the last years to smooth risks in disease mapping. However, most of these modeling approaches do not take possible local discontinuities into consideration or if they do, they are computationally prohibitive or simply do not work when the number of small areas is large. In this paper, we propose a two-step method to deal with discontinuities and to smooth noisy risks in small areas. In a first stage, a novel density-based clustering algorithm is used. In contrast to previous proposals, this algorithm is able to automatically detect the number of spatial clusters, thus providing a single cluster structure. In the second stage, a Bayesian hierarchical spatial model that takes the cluster configuration into account is fitted, which accounts for the discontinuities in disease risk. To evaluate the performance of this new procedure in comparison to previous proposals, a simulation study has been conducted. Results show competitive risk estimates at a much better computational cost. The new methodology is used to analyze stomach cancer mortality data in Spanish municipalities.
Open Access
Bayesian modeling approach in Big Data contexts: an application in spatial epidemiology
(IEEE, 2020) Orozco Acosta, Erick; Adin Urtasun, Aritz; Ugarte Martínez, María Dolores; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2; Estadística, Informática y Matemáticas
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.