A comparison of Bayesian spatial models for disease mapping.

With the advent of routine health data indexed at a fine geographical resolution, small area disease mapping studies have become an established technique in geographical epidemiology. The specific issues posed by the sparseness of the data and possibility for local spatial dependence belong to a generic class of statistical problems involving an underlying (latent) spatial process of interest corrupted by observational noise. These are naturally formulated within the framework of hierarchical models, and over the past decade, a variety of spatial models have been proposed for the latent level(s) of the hierarchy. In this article, we provide a comprehensive review of the main classes of such models that have been used for disease mapping within a Bayesian estimation paradigm, and report a performance comparison between representative models in these classes, using a set of simulated data to help illustrate their respective properties. We also consider recent extensions to model the joint spatial distribution of multiple disease or health indicators. The aim is to help the reader choose an appropriate structural prior for the second level of the hierarchical model and to discuss issues of sensitivity to this choice.