Prospective time periodic geographical disease surveillance using a scan statistic

Most disease registries are updated at least yearly. If a geographically localized health hazard suddenly occurs, we would like to have a surveillance system in place that can pick up a new geographical disease cluster as quickly as possible, irrespective of its location and size. At the same time, we want to minimize the number of false alarms. By using a space–time scan statistic, we propose and illustrate a system for regular time periodic disease surveillance to detect any currently 'active' geographical clusters of disease and which tests the statistical significance of such clusters adjusting for the multitude of possible geographical locations and sizes, time intervals and time periodic analyses. The method is illustrated on thyroid cancer among men in New Mexico 1973–1992.