In both cases,
Null hypothesis: cases occur independently AND with constant risk
Alternative hypothesis:
spatial clustering: stochastic dependence
spatial variation: non-constant risk
Distinction between stochastic dependence and non-constant risk is not sustainable empirically (and not always theoretically, without additional assumptions) (Bartlett, 1964).
A pragmatic strategy for problems of this kind, is to
try first to explain spatial variation in risk by adjusting for covariate effects before using stochastic models;
then use stochastic methods to analyse residual spatial effects
interpret small-scale residual effects as clustering, large-scale residual effects as variation in risk?
a scientific explanation always trumps a purely statistical one.