Detection of significant disease risks using a spatial conditional autoregressive model

SUMMARY: The conditional autoregressive (CAR) model is widely used to describe the geographical distribution of a specific disease risk in lattice mapping. Successful developments based on frequentist and Bayesian procedures have been extensively applied to obtain two-stage disease risk predictions at the subregional level. Bayesian procedures are preferred for making inferences, as the posterior standard errors (SE) of the two-stage prediction account for the variability in the variance component estimates; however, some recent work based on frequentist procedures and the use of bootstrap adjustments for the SE has been undertaken. In this article we investigate the suitability of an analytical adjustment for disease risk inference that provides accurate interval predictions by using the penalized quasilikelihood (PQL) technique to obtain model parameter estimates. The method is a first-order approximation of the naive SE based on a Taylor expansion and is interpreted as a conditional measure of variability providing conditional calibrated prediction intervals, given the data. We conduct a simulation study to demonstrate how the method can be used to estimate the specific subregion risk by interval. We evaluate the proposed methodology by analyzing the commonly used example data set of lip cancer incidence in the 56 counties of Scotland for the period 1975-1980. This evaluation reveals a close similarity between the solutions provided by the method proposed here and those of its fully Bayesian counterpart.