The Influence of Disease Mapping Methods on Spatial Patterns and Neighborhood Characteristics for Health Risk

This thesis addresses three interrelated challenges of disease mapping and contributes a new approach for improving visualization of disease burdens to enhance disease surveillance systems. First, it determines an appropriate threshold choice (smoothing parameter) for the adaptive kernel density estimation (KDE) in disease mapping. The results show that the appropriate threshold value depends on the characteristics of data, and bandwidth selector algorithms can be used to guide such decisions about mapping parameters. Similar approaches are recommended for map-makers who are faced with decisions about choosing threshold values for their own data. This can facilitate threshold selection. Second, the study evaluates the relative performance of the adaptive KDE and spatial empirical Bayes for disease mapping. The results reveal that while the estimated rates at the state level computed from both methods are identical, those at the zip code level are slightly different. These findings indicate that using either the adaptive KDE or spatial empirical Bayes method to map disease in urban areas may provide identical rate estimates, but caution is necessary when mapping diseases in non-urban (sparsely populated) areas. This study contributes insights on the relative performance in terms of accuracy of visual representation and associated limitations. Lastly, the study contributes a new approach for delimiting spatial units of disease risk using straightforward statistical and spatial methods and social determinants of health. The results show that the neighborhood risk map not only helps in geographically targeting where but also in tailoring interventions in those areas to those high risk populations. Moreover, when health data is limited, the neighborhood risk map alone is adequate for identifying where and which populations are at risk. These findings will benefit public health tasks of planning and targeting appropriate intervention even in areas with limited and poor-quality health data. This study not only fills the identified gaps of knowledge in disease mapping but also has a wide range of broader impacts. The findings of this study improve and enhance the use of the adaptive KDE method in health research, provide better awareness and understanding of disease mapping methods, and offer an alternative method to identify populations at risk in areas with limited health data. Overall, these findings will benefit public health practitioners and health researchers as well as enhance disease surveillance systems