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Accurate estimates of the under-five mortality rate in a developing world context are a key barometer of the health of a nation. This paper describes a new model to analyze survey data on mortality in this context. We are interested in both spatial and temporal description, that is wishing to estimate under-five mortality rate across regions and years and to investigate the association between the under-five mortality rate and spatially varying covariate surfaces. We illustrate the methodology by producing yearly estimates for subnational areas in Kenya over the period 1980-2014 using data from the Demographic and Health Surveys, which use stratified cluster sampling. We use a binomial likelihood with fixed effects for the urban/rural strata and random effects for the clustering to account for the complex survey design. Smoothing is carried out using Bayesian hierarchical models with continuous spatial and temporally discrete components. A key component of the model is an offset to adjust for bias due to the effects of HIV epidemics. Substantively, there has been a sharp decline in Kenya in the under-five mortality rate in the period 1980-2014, but large variability in estimated subnational rates remains. A priority for future research is understanding this variability. In exploratory work, we examine whether a variety of spatial covariate surfaces can explain the variability in under-five mortality rate. Temperature, precipitation, a measure of malaria infection prevalence, and a measure of nearness to cities were candidates for inclusion in the covariate model, but the interplay between space, time, and covariates is complex. [ABSTRACT FROM AUTHOR]

In recent years, disease mapping studies have become a routine application within geographical epidemiology and are typically analysed within a Bayesian hierarchical model formulation. A variety of model formulations for the latent level have been proposed but all come with inherent issues. In the classical BYM (Besag, York and Mollié) model, the spatially structured component cannot be seen independently from the unstructured component. This makes prior definitions for the hyperparameters of the two random effects challenging. There are alternative model formulations that address this confounding; however, the issue on how to choose interpretable hyperpriors is still unsolved. Here, we discuss a recently proposed parameterisation of the BYM model that leads to improved parameter control as the hyperparameters can be seen independently from each other. Furthermore, the need for a scaled spatial component is addressed, which facilitates assignment of interpretable hyperpriors and make these transferable between spatial applications with different graph structures. The hyperparameters themselves are used to define flexible extensions of simple base models. Consequently, penalised complexity priors for these parameters can be derived based on the information-theoretic distance from the flexible model to the base model, giving priors with clear interpretation. We provide implementation details for the new model formulation which preserve sparsity properties, and we investigate systematically the model performance and compare it to existing parameterisations. Through a simulation study, we show that the new model performs well, both showing good learning abilities and good shrinkage behaviour. In terms of model choice criteria, the proposed model performs at least equally well as existing parameterisations, but only the new formulation offers parameters that are interpretable and hyperpriors that have a clear meaning. [ABSTRACT FROM AUTHOR]

Age-period-cohort (APC) models are used to analyse data from disease registers given by age and time. When data are stratified by one further variable, for example geographical location, multivariate APC (MAPC) models can be applied to identify and estimate heterogeneous time trends across the different strata. In such models, outcomes share a set of parameters, typically the age effects, while the remaining parameters may differ across strata. In this article, we propose a conditional approach for inference to directly model relative time trends. We show that in certain situations the conditional approach can handle unmeasured confounding so that relative risks might be estimated with higher precision. Furthermore, we propose an extension for data with more stratification levels. Maximum likelihood estimation is performed using software for multinomial logistic regression. The usage of smoothing splines is suggested to stabilise estimates of relative time trends, if necessary. We apply the methodology to chronic obstructive pulmonary disease mortality data in England & Wales, stratified by three different areas and gender. [ABSTRACT FROM PUBLISHER]

Fine-scale covariate rasters are routinely used in geostatistical models for mapping demographic and health indicators based on household surveys from the Demographic and Health Surveys (DHS) program. However, the geostatistical analyses ignore the fact that GPS coordinates in DHS surveys are jittered for privacy purposes. We demonstrate the need to account for this jittering, and we propose a computationally efficient approach that can be routinely applied. We use the new method to analyse the prevalence of completion of secondary education for 20-49 year old women in Nigeria in 2018 based on the 2018 DHS survey. The analysis demonstrates substantial changes in the estimates of spatial range and fixed effects compared to when we ignore jittering. Through a simulation study that mimics the dataset, we demonstrate that accounting for jittering reduces attenuation in the estimated coefficients for covariates and improves predictions. The results also show that the common approach of averaging covariate values in windows around the observed locations does not lead to the same improvements as accounting for jittering. [ABSTRACT FROM AUTHOR]