Some contributions in disease mapping modeling

Abstract

Disease mapping has received great interest for the past three decades. This research area pursues the study of the geographical distribution of health-related events, such as mortality or the incidence of diseases, aggregated in geographic units, in order to mainly identify those locations that show a higher risk. The application of advanced statistical methods to carry risk estimates out is essential to obtain accurate estimates and to improve the understanding of the geographical distribution of diseases. In this thesis, we focus on the application and evaluation of several relevant modeling proposals, emerged in the disease mapping literature, to estimate the mortality geographic distribution, considering different scenarios with real data. Specifically, we study the distribution of mortality at the census tract level in the main cities of the Valencian Region and at the municipal level in the Valencian Region and in the whole of Spain. The evaluation of these previously published proposals reveals some statistical problems in their implementations. Therefore, our main goal with this thesis is the development of new methodological proposals that allow solving the problems of these previously published proposals. Likewise, we also pursue the development of an advanced national mortality atlas that allows to interactively visualize the geographical distribution, and the temporal evolution, of mortality for a large number of causes and throughout a long period of study in the whole of Spain. This thesis is a compendium of three articles and an additional work, which are structured as follows. In Chapter 1, we present a general introduction, including a description of the objectives, the data analyzed in each work and the software used. In Chapter 2, we introduce the general problem of disease mapping, as well as the modeling proposals that have been improved in each of our works. We also summarize the limitations found in these proposals and the new modeling proposals developed in this thesis. Chapter 3 summarizes the main results obtained in each of the subsequent works. Chapters 4, 5 and 6 contain the three published research articles that make up this compendium. In Chapter 7, we describe the methodology used in the development of the Spanish National Atlas of Mortality and its main characteristics and results. Finally, in Chapter 8, we present some conclusions and possible lines of future work.