Discovering Spatial Patterns of Readmission Risk Using a Bayesian Competing Risks Model with Spatially Varying Coefficients

Abstract

Time-to-event models are commonly used to study associations between risk factors and disease outcomes in the setting of electronic health records (EHR). In recent years, focus has intensified on social determinants of health, highlighting the need for methods that account for patients' locations. We propose a Bayesian approach for introducing point-referenced spatial effects into a competing risks proportional hazards model. Our method leverages Gaussian process (GP) priors for spatially varying intercept and slope. To improve computational efficiency under a large number of spatial locations, we implemented a Hilbert space low-rank approximation of the GP. We modeled the baseline hazard curves as piecewise constant, and introduced a novel multiplicative gamma process prior to induce shrinkage and smoothing. A loss-based clustering method was then used on the spatial random effects to identify high-risk regions. We demonstrate the utility of this method through simulation and a real-world analysis of EHR data from Duke Hospital to study readmission risk of elderly patients with upper extremity fractures. Our results showed that the proposed method improved inference efficiency and provided valuable insights for downstream policy decisions.