Disease maps are powerful tools for depicting spatial variations in disease risk and its underlying drivers.  However, producing effective disease maps requires careful consideration of the statistical and spatial properties of the disease data. In fact, the choice of mapping method influences the resulting spatial pattern of the disease, as well as the understanding of its underlying population characteristics. New developments in mapping methods and software in addition to continuing improvements in data quality and quantity are requiring map-makers to make a multitude of decisions before a map of disease burdens can be created. The impact of such decisions on a map, including the choice of appropriate mapping method, not been addressed adequately in the literature. This research demonstrates how choice of mapping method and associated parameters influence the spatial pattern of disease. We use four different disease-mapping methods – unsmoothed choropleth maps, smoothed choropleth maps produced using the headbanging method, smoothed kernel density maps, and smoothed choropleth maps produced using spatial empirical Bayes methods and 5-years of zip code level HIV incidence (2007- 2011) data from Dallas and Tarrant Counties, Texas. For each map, the leading population characteristics and their relative importance with regards to HIV incidence is identified using a regression analysis of a CDC recommended list of socioeconomic determinants of HIV. Our results show that the choice of mapping method leads to different conclusions regarding the associations between HIV disease burden and the underlying demographic and socioeconomic characteristics. Thus, the choice of mapping method influences the patterns of disease we see or fail to see. Accurate depiction of areas of high disease burden is important for developing and targeting appropriate public health interventions.

In this paper, I will show how applying a spatially explicit context to an existing environmental health surveillance framework is vital for more complete surveillance of disease, and for disease prevention and intervention strategies. As a case study to test the viability of a spatial approach to this existing framework, the risk of human exposure to Lyme disease will be estimated. This spatially explicit framework divides the surveillance process into three components: hazard surveillance, exposure surveillance, and outcome surveillance. The components will be used both collectively and individually, to assess exposure risk to infected ticks. By utilizing all surveillance components, I will identify different areas of risk which would not have been identified otherwise. Hazard surveillance uses maximum entropy modeling and geographically weighted regression analysis to create spatial models that predict the geographic distribution of ticks in Texas. Exposure surveillance uses GIS methods to estimate the risk of human exposures to infected ticks, resulting in a map that predicts the likelihood of human-tick interactions across Texas, using LandScan 2008TM population data. Lastly, outcome surveillance uses kernel density estimation-based methods to describe and analyze the spatial patterns of tick-borne diseases, which results in a continuous map that reflects disease rates based on population location. Data for this study was obtained from the Texas Department of Health Services and the University of North Texas Health Science Center. The data includes disease data on Lyme disease from 2004-2008, and the tick distribution estimates are based on field collections across Texas from 2004-2008.