Analyzing the Relationship Between Smoking and Coronary Heart Disease at the Small Area Level: A Bayesian Approach to Spatial Modeling

We model the relationship between coronary heart disease and smoking prevalence and deprivation at the small area level using the Poisson log-linear model with and without random effects. Extra-Poisson variability (overdispersion) is handled through the addition of spatially structured and unstructured random effects in a Bayesian framework. In addition, four different measures of smoking prevalence are assessed because the smoking data are obtained from a survey that resulted in quite large differences in the size of the sample across the census tracts. Two of the methods use Bayes adjustments of standardized smoking ratios (local and global adjustments), and one uses a nonparametric spatial averaging technique. A preferred model is identified based on the deviance information criterion. Both smoking and deprivation are found to be statistically significant risk factors, but the effect of the smoking variable is reduced once the confounding effects of deprivation are taken into account. Maps of the spatial variability in relative risk, and the importance of the underlying covariates and random effects terms, are produced. We also identify areas with excess relative risk