Comparison of estimation methods for creating small area rates of acute myocardial infarction among Medicare beneficiaries in California

Creating local population health measures from administrative data would be useful for health policy and public health monitoring purposes. While a wide range of options - from simple spatial smoothers to model-based methods - for estimating such rates exists, there are relatively few side-by-side comparisons, especially not with real-world data. In this paper, we compare methods for creating local estimates of acute myocardial infarction rates from Medicare claims data. A Bayesian Monte Carlo Markov Chain estimator that incorporated spatial and local random effects performed best, followed by a method-of-moments spatial Empirical Bayes estimator. As the former is more complicated and time-consuming, spatial linear Empirical Bayes methods may represent a good alternative for non-specialist investigators.