Testing for Poisson Zero Inflation in Disease Mapping

When analyzing mortality data due to rare diseases in small areas, it is common to find several health zones with no mortality cases. In these circumstances, the classical homogeneous model based on the Poisson distribution used to estimate the relative risks within each area may encounter lack of fit due to a disproportionately large frequency of zeros. To cope with these zeros, the zero inflated Poisson model can be used. In this paper, we propose a test for detecting zero inflation in the context of disease mapping which is based on bootstrap techniques. The test is illustrated using male mortality data due to brain cancer in Navarra, Spain. In addition, comparisons with other tests for Poisson zero inflation such as the score test and the likelihood ratio test are carried out in terms of empirical power and size using the brain cancer scenario. The proposed bootstrap test has good power and size and works well when detecting the excess of zeros in small area data sets. (© 2004 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)