Estimating multilevel regional variation in excess mortality of cancer patients using integrated nested Laplace approximation

This study assessed the performance of the integrated nested Laplace approximation (INLA) in monitoring regional variation in cancer survival. Poisson regression model of excess mortality including both spatially correlated and unstructured random effects was fitted to the data of patients diagnosed with ovarian and breast cancer in Finland during 1955 ‐2014 with follow up from 1960 through 2014 by using the period approach with five‐year calendar time windows. We estimated standard deviations associated with variation (i) between hospital districts and (ii) between municipalities within hospital districts. Posterior estimates based on the INL A approach were compared to those based on the MCMC simulation. The estimates of the variation parameters were similar between the two approaches. Variation within hospital districts dominated in the total variation between municipalities. In 2000‐2014, the proportion of the average variation with in hospital districts was 68% (95% posterior interval: 35%‐93%) and 82% (60%‐98%) out of the total variation in ovarian and breast cancer, respectively. In the estimation of regional variation, the INLA approach was accurate, fast, and easy to implement by using the R‐INLA package.
Source: Statistics in Medicine - Category: Statistics Authors: Tags: RESEARCH ARTICLE Source Type: research