A class of tests for detecting 'general' and 'focused' clustering of rare diseases

This paper proposes a class of tests applicable to the detection of two types of disease clustering 'focused' and 'general' clustering. The former assesses the clustering of observed cases around the fixed point and the latter does not have any prior information on the centre of clustering. The proposed test for 'general' clustering is a generalization of the index for temporal clustering proposed by Tango in that it adjusts for differences in population densities and also in population distributions among categories of the counfounders such as age and sex. Simulation study shows that the proposed 'general' test outperformed the average distance method of Whittemore et al. in most of the cluster models considered.