Detecting Spatial Health Disparities Using Disease Maps

Epidemiologists commonly use regional aggregates of health outcomes to map mortality or incidence rates and identify geographic disparities. However, to detect health disparities across regions, it is necessary to identify "difference boundaries" that separate neighboring regions with significantly different spatial effects. This can be particularly challenging when dealing with multiple outcomes for each unit and accounting for dependence among diseases and across areal units. In this study, we address the issue of multivariate difference boundary detection for correlated diseases by formulating the problem in terms of Bayesian pairwise multiple comparisons by extending it through the introduction of adjacency modeling and disease graph dependencies. Specifically, we seek the posterior probabilities of neighboring spatial effects being different. To accomplish this, we adopt a class of multivariate areally referenced Dirichlet process models that accommodate spatial and interdisease dependence by endowing the spatial random effects with a discrete probability law. Our method is evaluated through simulation studies and applied to detect difference boundaries for multiple cancers using data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.