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Triple-goal estimates for disease mapping.

Maps of regional morbidity and mortality rates play an important role in assessing environmental equity. They provide effective tools for identifying areas with potentially elevated risk, determining spatial trend, and formulating and validating aetiological hypotheses about disease. Bayes and empirical Bayes methods produce stable small-area rate estimates that retain geographic and demographic resolution. The beauty of the Bayesian approach lies in its ability to structure complicated models, inferential goals and analyses. Three inferential goals are relevant to disease mapping and risk assessment: (i) computing accurate estimates of disease rates in small geographic areas; (ii) estimating the distribution of disease rates over the region; (iii) ranking the disease rates so that environmental investigation can be prioritized. No single set of estimates can simultaneously optimize these three goals, and Shen and Louis propose a set of estimates that perform well on all three goals. These are optimal for estimating the distribution of rates and for ranking, and maintain a high accuracy in estimating area-specific rates. However, the Shen/Louis method is sensitive to choice of priors. To address this issue we introduce a robustified version of the method based on a smoothed non-parametric estimate of the prior. We evaluate the performance of this method through a simulation study, and illustrate it using a data set of county-specific lung cancer rates in Ohio.