Modelling spatial heterogeneity in exposure buffers and risk: a hierarchical Bayesian approach

Place-based epidemiology studies often rely on circular buffers to define 'exposure' to spatially distributed risk factors, where the buffer radius represents a threshold beyond which exposure does not influence the outcome of interest. This approach is popular due to its simplicity and alignment with public health policies. However, buffer radii are often chosen relatively arbitrarily and assumed constant across the spatial domain. This may result in suboptimal statistical inference if these modelling choices are incorrect. To address this, we develop spatially varying buffer radii (SVBR), a flexible hierarchical Bayesian spatial change points approach that treats buffer radii as unknown parameters and allows both radii and exposure effects to vary spatially. Through simulations, we find that SVBR improves estimation and inference for key model parameters compared to traditional methods. We also apply SVBR to study healthcare access in Madagascar, finding that proximity to healthcare facilities generally increases antenatal care usage, with clear spatial variation in this relationship. By relaxing rigid assumptions about buffer characteristics, our method offers a flexible, data-driven approach to accurately defining exposure and quantifying its impact. The newly developed methods are available in the R package EpiBuffer.