Spatial Scan Statistics Adjusted for Multiple Clusters

The spatial scan statistic is one of the main epidemiological tools to test for the presence of disease clusters in a geographical region. While the statistical significance of the most likely cluster is correctly assessed using the model assumptions, secondary clusters tend to have conservatively high P -values. In this paper, we propose a sequential version of the spatial scan statistic to adjust for the presence of other clusters in the study region. The procedure removes the effect due to the more likely clusters on less significant clusters by sequential deletion of the previously detected clusters. Using the Northeastern United States geography and population in a simulation study, we calculated the type I error probability and the power of this sequential test under different alternative models concerning the locations and sizes of the true clusters. The results show that the type I error probability of our method is close to the nominal level and that for secondary clusters its power is higher than the standard unadjusted scan statistic.