A flexible parametric approach to examining spatial variation in relative survival
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Mengersen, Kerrie L
Lambert, Paul C
Ryan, Louise M
Baade, Peter D
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Abstract
Most of the few published models used to obtain small-area estimates of relative survival are based on a generalized linear model with piecewise constant hazards under a Bayesian formulation. Limitations of these models include the need to artificially split the time scale, restricted ability to include continuous covariates, and limited predictive capacity. Here, an alternative Bayesian approach is proposed: a spatial flexible parametric relative survival model. This overcomes previous limitations by combining the benefits of flexible parametric models: the smooth, well-fitting baseline hazard functions and predictive ability, with the Bayesian benefits of robust and reliable small-area estimates. Both spatially structured and unstructured frailty components are included. Spatial smoothing is conducted using the intrinsic conditional autoregressive prior. The model was applied to breast, colorectal, and lung cancer data from the Queensland Cancer Registry across 478 geographical areas. Advantages of this approach include the ease of including more realistic complexity, the feasibility of using individual-level input data, and the capacity to conduct overall, cause-specific, and relative survival analysis within the same framework. Spatial flexible parametric survival models have great potential for exploring small-area survival inequalities, and we hope to stimulate further use of these models within wider contexts. Copyright © 2016 John Wiley & Sons, Ltd.
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Statistics in Medicine
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35
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29
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© 2016 John Wiley & Sons, Ltd. This is the peer reviewed version of the following article: Cramb, SM; Mengersen, KL; Lambert, PC; Ryan, LM; Baade, PD, A flexible parametric approach to examining spatial variation in relative survival, Statistics in Medicine, 2016, 35 (29), pp. 5448-5463, which has been published in final form at https://doi.org/10.1002/sim.7071. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
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Statistics
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Cramb, SM; Mengersen, KL; Lambert, PC; Ryan, LM; Baade, PD, A flexible parametric approach to examining spatial variation in relative survival, Statistics in Medicine, 2016, 35 (29), pp. 5448-5463