Hierarchical Bayesian bivariate disease mapping: analysis of children and adults asthma visits to hospital

In spatial epidemiology, detecting areas with high ratio of disease is important as it may lead to identifying risk factors associated with disease. This in turn may lead to further epidemiological investigations into the nature of disease. Disease mapping studies have been widely performed with considering only one disease in the estimated models. Simultaneous modelling of different diseases can also be a valuable tool both from the epidemiological and also from the statistical point of view. In particular, when we have several measurements recorded at each spatial location, one can consider multivariate models in order to handle the dependence among the multivariate components and the spatial dependence between locations. In this paper, spatial models that use multivariate conditionally autoregressive smoothing across the spatial dimension are considered. We study the patterns of incidence ratios and identify areas with consistently high ratio estimates as areas for further investigation. A hierarchical Bayesian approach using Markov chain Monte Carlo techniques is employed to simultaneously examine spatial trends of asthma visits by children and adults to hospital in the province of Manitoba, Canada, during 2000--2010.