Multiple testing on standardized mortality ratios: a Bayesian hierarchical model for FDR estimation.

The analysis of large data sets of standardized mortality ratios (SMRs), obtained by collecting observed and expected disease counts in a map of contiguous regions, is a first step in descriptive epidemiology to detect potential environmental risk factors. A common situation arises when counts are collected in small areas, that is, where the expected count is very low, and disease risks underlying the map are spatially correlated. Traditional p-value-based methods, which control the false discovery rate (FDR) by means of Poisson p-values, might achieve small sensitivity in identifying risk in small areas. This problem is the focus of the present work, where a Bayesian approach which performs a test to evaluate the null hypothesis of no risk over each SMR and controls the posterior FDR is proposed. A Bayesian hierarchical model including spatial random effects to allow for extra-Poisson variability is implemented providing estimates of the posterior probabilities that the null hypothesis of absence of risk is true. By means of such posterior probabilities, an estimate of the posterior FDR conditional on the data can be computed. A conservative estimation is needed to achieve the control which is checked by simulation. The availability of this estimate allows the practitioner to determine nonarbitrary FDR-based selection rules to identify high-risk areas according to a preset FDR level. Sensitivity and specificity of FDR-based rules are studied via simulation and a comparison with p-value-based rules is also shown. A real data set is analyzed using rules based on several FDR levels.