Spatial Scan Statistics [1] usually assume Poisson or Binomial distributed data, which is not adequate in many disease surveillance scenarios. For example, small areas distant from hospitals may exhibit a smaller number of cases than expected in those simple models. Also, underreporting may occur in underdeveloped regions, due to inefficient data collection or the difficulty to access remote sites. Those factors generate excess zero case counts or overdispersion, inducing a violation of the statistical model and also increasing the type I error (false alarms). Overdispersion occurs when data variance is greater than the predicted by the used model. To accommodate it, an extra parameter must be included; in the Poisson model, one makes the variance equal to the mean.
Objective
To propose a more realistic model for disease cluster detection, through a modification of the spatial scan statistic to account simultaneously for inflated zeros and overdispersion.