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Department of Neurology (Drs. Armon and Daube), the Section of Biostatistics (Dr. O'Brien), and the Section of Clinical Epidemiology (Dr. Kurland), Mayo Clinic and Mayo Foundation, Rochester, MN; Dr. Mulder is an emeritus member of the Department of Neurology.
To conserve clinical and public health resources, it is necessary to screen reports from the community of an excess or cluster of cases of chronic neurologic diseases for potential epidemiologic significance, ie, to identify those clusters that may have occurred owing to the operation of an underlying etiologic cause rather than to chance alone. Traditionally, the probability that such a cluster has occurred by chance within the reporting community is computed, ignoring the fact that many other similar communities have not reported a cluster. We propose a modified approach that takes this larger universe of communities into account, thereby raising the threshold for potential epidemiologic significance. As a result, the lowest value for the ratio of observed-to-expected cases that may be considered of epidemiologic significance should be increased by factors of 2 for small clusters (one to three expected cases), 1.5 for intermediate clusters (seven to 30 expected cases), and 1.3 for large clusters (60 to 90 expected cases). Consequently, case ascertainment and full field investigations can be reserved for only those reports that, if confirmed, would represent a cluster not due to chance alone. We illustrate this with a case from our own experience.
Address correspondence and reprint requests to Dr. L.T. Kurland, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Supported in part by the Neuroepidemiologic Program Project Grant NS 17750 from the National Institute of Neurological and Communicative Disorders and Stroke.
Presented in part at the 114th annual meeting of the American Neurological Association, New Orleans, LA, September 1989.
Received February 22, 1991. Accepted for publication in final form May 8, 1991.
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