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A critical look at prospective surveillance using a scan statistic.

Thais R Correa1, Renato M Assunção, Marcelo A Costa

  • 1Departamento de Estatística, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Statistics in Medicine
|December 24, 2014
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Summary

The scan statistic method is not suitable for prospective disease surveillance. It fails to properly adjust for repeated testing, leading to unreliable significance levels and ineffective error control.

Keywords:
average run lengthp-valuerecurrence intervalscan statistic

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Area of Science:

  • Epidemiology
  • Biostatistics
  • Public Health Surveillance

Background:

  • The scan statistic is a widely used surveillance technique for spatial, temporal, and spatial-temporal disease data.
  • It has been adapted for prospective surveillance, but its appropriateness in this context is questioned.

Purpose of the Study:

  • To evaluate the suitability of the scan statistic method with standard signal rules for prospective disease surveillance.
  • To assess the impact of sequential and repeated testing on the method's statistical validity.

Main Methods:

  • Analysis of the scan statistic's performance under prospective surveillance conditions.
  • Examination of the relationship between nominal significance level (α) and surveillance performance metrics like recurrence interval and average run length (ARL).

Main Results:

  • The scan statistic does not adequately adjust for sequential and repeated testing in prospective surveillance.
  • The nominal significance level (α) loses its meaning, and its relationship with recurrence interval and ARL is undefined.
  • In certain scenarios, the average run length (ARL) can become infinite, rendering the method ineffective.

Conclusions:

  • The scan statistic, when used with conventional signal rules, is inappropriate for prospective disease surveillance.
  • The method fails to control Type-I error probability and maintain a meaningful average run length.
  • Strong opposition to using the scan statistic with usual signal rules in prospective surveillance is recommended due to lack of statistical validity.