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Roman E, Kane E, Smith A, Howell D, Sheridan R, Simpson J, Bonaventure A, Kinsey S. Cohort profile: the United Kingdom Childhood Cancer Study (UKCCS) - a UK-wide population-based study examining the health of cancer survivors. BMJ Open 2023; 13:e073712. [PMID: 37977872 PMCID: PMC10660444 DOI: 10.1136/bmjopen-2023-073712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE The United Kingdom Childhood Cancer Study's (UKCCS's) matched cohort was established to examine the longer term morbidity and mortality of individuals previously diagnosed with cancer before 15 years of age, comparing future healthcare patterns in 5-year cancer survivors to baseline activity seen in age- and sex-matched individuals from the general population. PARTICIPANTS Predicated on a national childhood cancer case-control study conducted in the early 1990s (4430 cases, 9753 controls) in England, Scotland and Wales, the case population comprises 3125 cancer survivors (>5 years), and the control population 7156 age- and sex-matched individuals from the general population who did not have cancer as a child. Participants are now being followed up via linkage to national administrative healthcare databases (deaths, cancers and secondary care hospital activity). FINDINGS TO DATE Enabling the creation of cohorts with minimal selection bias and loss to follow-up, the original case-control study registered all newly diagnosed cases of childhood cancer and their corresponding controls, regardless of their family's participation. Early findings based on the registered case population found marked survival variations with age and sex across subtypes and differences with deprivation among acute lymphoblastic leukaemia (ALL) survivors. More recently, comparing the health-activity patterns of the case and control populations revealed that survivors of childhood ALL experienced excess outpatient and inpatient activity across their teenage/young adult years. Adding to increased risks of cancer and death and involving most clinical specialties, excesses were not related to routine follow-up monitoring and showed no signs of diminishing over time. FUTURE PLANS With annual linkage updates, the UKCCS's maturing population-based matched cohorts provide the foundation for tracking the health of individuals through their lifetime. Comparing the experience of childhood cancer survivors to that of unaffected general-population counterparts, this will include examining subsequent morbidity and mortality, secondary care hospital activity and the impact of deprivation on longer term outcomes.
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Affiliation(s)
- Eve Roman
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Eleanor Kane
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Alexandra Smith
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Debra Howell
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Rebecca Sheridan
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Jill Simpson
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Audrey Bonaventure
- INSERM, Université Paris Cité and Université Sorbonne Paris Nord, Paris, Île-de-France, France
| | - Sally Kinsey
- Paediatric Haematology, Leeds Children's Hospital, Leeds, West Yorkshire, UK
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Wheeler DC, Boyle J, Carli M, Ward MH, Metayer C. Neighborhood Deprivation, Indoor Chemical Concentrations, and Spatial Risk for Childhood Leukemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3582. [PMID: 36834278 PMCID: PMC9968201 DOI: 10.3390/ijerph20043582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Leukemia is the most common childhood cancer in industrialized countries, and the increasing incidence trends in the US suggest that environmental exposures play a role in its etiology. Neighborhood socioeconomic status (SES) has been found to be associated with many health outcomes, including childhood leukemia. In this paper, we used a Bayesian index model approach to estimate a neighborhood deprivation index (NDI) in the analysis of childhood leukemia in a population-based case-control study (diagnosed 1999 to 2006) in northern and central California, with direct indoor measurements of many chemicals for 277 cases and 306 controls <8 years of age. We considered spatial random effects in the Bayesian index model approach to identify any areas of significantly elevated risk not explained by neighborhood deprivation or individual covariates, and assessed if groups of indoor chemicals would explain any elevated spatial risk areas. Due to not all eligible cases and controls participating in the study, we conducted a simulation study to add non-participants to evaluate the impact of potential selection bias when estimating NDI effects and spatial risk. The results in the crude model showed an odds ratio (OR) of 1.06 and 95% credible interval (CI) of (0.98, 1.15) for a one unit increase in the NDI, but the association became slightly inverse when adjusting for individual level covariates in the observed data (OR = 0.97 and 95% CI: 0.87, 1.07), as well as when using simulated data (average OR = 0.98 and 95% CI: 0.91, 1.05). We found a significant spatial risk of childhood leukemia after adjusting for NDI and individual-level covariates in two counties, but the area of elevated risk was partly explained by selection bias in simulation studies that included more participating controls in areas of lower SES. The area of elevated risk was explained when including chemicals measured inside the home, and insecticides and herbicides had greater effects for the risk area than the overall study. In summary, the consideration of exposures and variables at different levels from multiple sources, as well as potential selection bias, are important for explaining the observed spatial areas of elevated risk and effect estimates.
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Affiliation(s)
- David C. Wheeler
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, Richmond, VA 23298, USA
| | - Joseph Boyle
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, Richmond, VA 23298, USA
| | - Matt Carli
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, Richmond, VA 23298, USA
| | - Mary H. Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Catherine Metayer
- School of Public Health, University of California Berkeley, Berkeley, CA 94704, USA
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Kane E, Kinsey S, Bonaventure A, Johnston T, Simpson J, Howell D, Smith A, Roman E. Excess morbidity and mortality among survivors of childhood acute lymphoblastic leukaemia: 25 years of follow-up from the United Kingdom Childhood Cancer Study (UKCCS) population-based matched cohort. BMJ Open 2022; 12:e056216. [PMID: 35256445 PMCID: PMC8905881 DOI: 10.1136/bmjopen-2021-056216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine morbidity and mortality among teenagers and young adults (TYAs) previously diagnosed with acute lymphoblastic leukaemia (ALL) in childhood, and compare to the general TYA population. DESIGN National population-based sex-matched and age-matched case-control study converted into a matched cohort, with follow-up linkage to administrative healthcare databases. SETTING The study population comprised all children (0-14 years) registered for primary care with the National Health Service (NHS) in England 1992-1996. PARTICIPANTS 1082 5-year survivors of ALL diagnosed<15 years of age (1992-1996) and 2018 unaffected individuals; followed up to 15 March 2020. MAIN OUTCOME MEASURES Associations with hospital activity, cancer and mortality were assessed using incidence rate ratios (IRR) and differences. RESULTS Mortality in the 5-year ALL survivor cohort was 20 times higher than in the comparison cohort (rate ratio 21.3, 95% CI 11.2 to 45.6), and cancer incidence 10 times higher (IRR 9.9 95% CI 4.1 to 29.1). Hospital activity was increased for many clinical specialties, the strongest associations being for endocrinology; outpatient IRR 36.7, 95% CI 17.3 to 93.4 and inpatient 19.7, 95% CI 7.9 to 63.2 for males, and 11.0, 95% CI 6.2 to 21.1 and 6.2 95% CI 3.1 to 13.5, respectively, for females. Notable excesses were also evident for cardiology, neurology, ophthalmology, respiratory medicine and general medicine. Males were also more likely to attend gastroenterology; ear, nose and throat; urology; and dermatology, while females were more likely to be seen in plastic surgery and less likely in midwifery. CONCLUSIONS Adding to excess risks of death and cancer, survivors of childhood ALL experience excess outpatient and inpatient activity across their TYA years, which is not related to routine follow-up monitoring. Involving most clinical specialties, associations are striking, showing no signs of diminishing over time. Recognising that all survivors are potentially at risk of late treatment-associated effects, our findings underscore the need to take prior ALL diagnosis into account when interpreting seemingly unrelated symptoms later in life.
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Affiliation(s)
- Eleanor Kane
- Department of Health Sciences, University of York, York, UK
| | | | - Audrey Bonaventure
- Epidemiology of Childhood and Adolescent Cancers Team, INSERM, Paris, France
| | - Tom Johnston
- Department of Health Sciences, University of York, York, UK
| | - Jill Simpson
- Department of Health Sciences, University of York, York, UK
| | - Debra Howell
- Department of Health Sciences, University of York, York, UK
| | | | - Eve Roman
- Department of Health Sciences, University of York, York, UK
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Ologbenla A, Hu M, Hajizadeh M. Socioeconomic status and incidence of pediatric leukemia in Canada: 1992-2010. Cancer Epidemiol 2019; 61:14-22. [PMID: 31103934 DOI: 10.1016/j.canep.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Leukemia is the most common cancer among Canadian children, representing about a third of pediatric cancers in Canada and is responsible for about one-third of pediatric cancer deaths. Understanding the effect of socioeconomic status (SES) on pediatric leukemia incidence provides valuable information for cancer control and interventions in Canada. METHODS Using a linked data from the Canadian Cancer Registry (CCR), Canadian Census of Population (CCP) and National Household Survey (NHS) we aimed to quantify socioeconomic inequalities in the incidence of pediatric leukemia from 1992 to 2010. We used the concentration index (C) approach to quantify income- and education-related inequalities in the incidence of pediatric leukemia over time. RESULTS Though there were fluctuations in incidence over the study period, our results showed that the total incidence of pediatric leukemia in Canada was generally consistent from 1992 to 2010. Incidence rate of 47 per 1,000,000 as at 1992 rose to 57 per 1,000,000 in 2010. The estimated values of the C over the study period failed to show any significant association between pediatric leukemia incidence and household income or education status. CONCLUSIONS Although pediatric leukemia incidence is not rising significantly, it is not reducing significantly either. The incidence of pediatric leukemia showed no significant association with socioeconomic status. Future cancer control interventions should focus more on mitigating risk factors that are independent of socioeconomic status.
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Affiliation(s)
| | - Min Hu
- School of Health Administration, Dalhousie University, Halifax, Canada
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Precision medicine and health disparities: The case of pediatric acute lymphoblastic leukemia. Nurs Outlook 2019; 67:331-336. [PMID: 31279488 DOI: 10.1016/j.outlook.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Precision medicine has uncertain potential to address population health disparities. PURPOSE Case study of disparities in pediatric acute lymphoblastic leukemia (ALL). METHOD Literature-based evaluation of ALL in African American (AA) and European American (EA) children. FINDINGS AA children have a lower incidence of ALL than EA children, experience higher relapse rates, and are more likely to be diagnosed with poor prognostic indicators. Environmental risk exposures for ALL have small effect sizes; data are insufficient to determine their contribution to differences in incidence and prognosis. Differences in prevalence of gene variants associated with treatment response contribute to higher relapse rates in AA children. However, higher relapse rates were not seen in a care setting that eliminated out of pocket costs, used risk-directed therapy, and included rigorous case management. DISCUSSION Unequal access to effective treatment contributes to ALL disparities. Precision medicine can help to define effective treatment for diverse patient populations.
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Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Tran LT, Lai HTM, Koriyama C, Uwatoko F, Akiba S. The association between high birth weight and the risks of childhood CNS tumors and leukemia: an analysis of a US case-control study in an epidemiological database. BMC Cancer 2017; 17:687. [PMID: 29037176 PMCID: PMC5644053 DOI: 10.1186/s12885-017-3681-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background High birth weight (BW), 4000 g or larger, is an established risk factor for childhood leukemia. However, its association with central nervous system (CNS) tumor risk is yet unclear. The present study examined it, analyzing data obtained from a case-control study conducted among three states from the US. The association with childhood leukemia risk was also further examined. Methods In this study, a data set provided by the Comprehensive Epidemiologic Data Resource was analyzed with an official permission. The original case-control study was conducted to examine the association between paternal preconception exposure to ionizing radiation and childhood cancer risk. Cases with childhood cancer were mainly ascertained from local hospitals, and controls were selected, matched with birth year (1-year category), county of residence, sex, ethnicity and maternal age (+/−2 years). Since the ID numbers were unavailable, conventional logistic analyses were conducted adjusting for those matching variables except for the county of residence. In addition to those variables, gestational age, age at diagnosis and study sites as covariables were included in the logistic models. Results Analyzed subjects were 72 CNS tumor cases, 124 leukemia cases and 822 controls born from 1945 to 1989. The odds ratios (ORs) of CNS tumor risk for children with low BWs (<2500 g) and high BWs (>4000 g) were 2.0 (95% confidence interval [CI]) = 0.7, 5.9) and 2.5 (95%CI = 1.2, 5.2)], respectively. When high-BW children were restricted to those who were large for gestational age (LGA), the OR for high-BW children remained similar (OR = 2.7; 95%CI = 1.1, 6.2). On the other hand, the ORs of leukemia risk for children with low and high BWs were 0.8 (95%CI = 0.2, 3.0) and 1.4 (95%CI = 0.7, 2.6), respectively. In the normal range of BW (2500–4000 g), higher BW was positively associated with CNS tumor risk (beta = 0.0011, p for trend = 0.012). However, the association with leukemia risk was not significant (beta = −0.0002, p for trend = 0.475). Conclusion High-BW and LGA children had an elevated childhood CNS tumor risk. In the normal BW range, the BW itself was positively related to CNS tumor risk. No significant association between BW and childhood leukemia risk was observed in this study. Electronic supplementary material The online version of this article (10.1186/s12885-017-3681-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Long Thanh Tran
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hang Thi Minh Lai
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Futoshi Uwatoko
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Suminori Akiba
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan.
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Offor UT, Basta NO, James PW, McNally RJQ. Is there a socioeconomic variation in survival from renal tumours in children and young people resident in northern England (1968-2012)? Cancer Epidemiol 2017; 50:92-98. [PMID: 28843177 DOI: 10.1016/j.canep.2017.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite strong evidence of a social gradient in cancer survival among UK adults, studies in children and young people remain inconclusive and have not included renal tumours. This study investigated the relationship between socioeconomic status and survival from renal tumours among children and young people. PROCEDURE Kaplan-Meier estimation and Cox regression were used to analyse survival for all 209 renal tumours in children and young people (0-24 years) diagnosed 1968-2012 and registered by a specialist population-based registry. Sociodemographic and clinicopathologic variables, including paternal occupation at birth, were also analysed. RESULTS No significant disparity in overall renal tumour and Wilms tumour (WT) survival was observed according to paternal social class [p=0.988 and 0.808, respectively]. The strongest predictor of survival was stage, with late stage (III-IV) disease having a 4-fold higher risk of death compared to early stage (I-II) disease [p<0.001]. Similarly, high mortality-risk was seen for late stage WT in children aged 0-14 years (Hazard Ratio=6.37; 95% CI=2.60-15.59). CONCLUSIONS This study did not detect a significant social gradient in renal tumour survival. The identification of tumour stage as a strong predictor of survival irrespective of age, necessitates the development of appropriate public health interventions that target early diagnosis and treatment.
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Affiliation(s)
- Ugonna T Offor
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Nermine O Basta
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Peter W James
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Richard J Q McNally
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.
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Wang L, Gomez SL, Yasui Y. Racial and Ethnic Differences in Socioeconomic Position and Risk of Childhood Acute Lymphoblastic Leukemia. Am J Epidemiol 2017; 185:1263-1271. [PMID: 28369160 DOI: 10.1093/aje/kww164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
Abstract
Racial and ethnic differences in associations between socioeconomic position (SEP) and risk of childhood acute lymphoblastic leukemia (ALL) were investigated using data from population-based cancer registries in the Surveillance, Epidemiology, and End Results Program in the United States. The study included 8,383 ALL cases diagnosed at age ≤19 years in 2000-2010. Census tract-level composite SEP index in quintiles was assigned based on residence at the time of diagnosis. Incidence rate ratios and 95% confidence intervals associated with SEP and race/ethnicity, adjusted for sex, age, and year of diagnosis, were estimated using Poisson regression models. The incidence rate of childhood ALL was negatively associated with SEP among Hispanics but was positively associated among children of other races/ethnicities. As compared with the lowest SEP, the adjusted incidence rate ratios for children with the highest SEP were 1.29 (95% confidence interval (CI): 1.15, 1.44) for non-Hispanic whites, 1.67 (95% CI: 1.20, 2.34) for non-Hispanic blacks, 1.57 (95% CI: 1.17, 2.09) for Asians/Pacific Islanders, 2.33 (95% CI: 0.93, 5.83) for American Indians/Alaska Natives, and 0.70 (95% CI: 0.60, 0.81) for Hispanics. The findings of a reverse association in Hispanics need to be confirmed and further explained in future studies using different measures of SEP.
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Affiliation(s)
- Linwei Wang
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California (Scarlett Lin Gomez)
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California (Scarlett Lin Gomez)
- Stanford Cancer Institute, Stanford, California (Scarlett Lin Gomez)
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
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Spix C, Grosche B, Bleher M, Kaatsch P, Scholz-Kreisel P, Blettner M. Background gamma radiation and childhood cancer in Germany: an ecological study. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2017; 56:127-138. [PMID: 28337585 DOI: 10.1007/s00411-017-0689-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 03/11/2017] [Indexed: 06/06/2023]
Abstract
The relationship of low-dose background gamma radiation and childhood leukaemia was investigated in a number of studies. Results from these studies are inconclusive. Therefore, in the present study 25 years of German childhood cancer data were analyzed using interpolated background annual gamma dose rate per community in an ecological study. The main question was leukaemia; as exploratory questions we investigate central nervous system (CNS) tumours, thyroid carcinomas and diagnoses less likely to be related to radiation. A Poisson regression model was applied and a fractional polynomial model building procedure. As the main sensitivity analysis a community deprivation index was included as a potential confounder. It was found that outdoor background gamma annual dose rates in Germany range roughly from 0.5-1.5 mSv/a with an average of 0.817 mSv/a. No association of annual ambient gamma dose rates with leukaemia incidence was found. Amongst the exploratory analyses, a strong association was found with CNS tumour incidence [rate ratio for 1.5 vs 0.5 mSv/a: 1.35; 95% confidence interval (1.17, 1.57)]. The community level deprivation index was not a confounder. It is concluded that the present study did not confirm an association of annual outdoor ambient gamma dose rate and childhood leukaemia, corresponding to some studies and contrasting others. An association with CNS incidence was found in the exploratory analyses. As this is an ecological study no causal interpretation is possible.
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Affiliation(s)
- Claudia Spix
- German Childhood Cancer Registry at the Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany.
| | - Bernd Grosche
- Federal Office for Radiation Protection, 85764, Oberschleissheim, Germany
| | - Martin Bleher
- Federal Office for Radiation Protection, 85764, Oberschleissheim, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry at the Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
| | - Peter Scholz-Kreisel
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
| | - Maria Blettner
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
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Marquant F, Goujon S, Faure L, Guissou S, Orsi L, Hémon D, Lacour B, Clavel J. Risk of Childhood Cancer and Socio-economic Disparities: Results of the French Nationwide Study Geocap 2002-2010. Paediatr Perinat Epidemiol 2016; 30:612-622. [PMID: 27555468 DOI: 10.1111/ppe.12313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Socio-economic status is related to many life style and environmental factors, some of which have been suggested to influence the risk of childhood cancer. Studies requiring subject participation are usually hampered by selection of more educated parents. To prevent such bias, we used unselected nationwide Geographical Information System (GIS)-based registry data, to investigate the influence of socio-economic disparities on the risk of childhood cancer. METHODS The Geocap study included all French residents diagnosed with cancer aged up to 15 years over the period 2002-2010 (15 111 cases) and 45 000 contemporaneous controls representative of the childhood population. Area socio-economic characteristics used to calculate the European Deprivation Index (EDI) were based on census data collected on the fine scale of the Merged Islet for Statistical Information (IRIS). RESULTS Overall, the risk of acute lymphoblastic leukaemia (ALL) was lower in the most deprived quintile than in the other quintiles of EDI (ORQ5vs<Q5 0.80 (95% confidence interval (CI) 0.73, 0.88)). The odds ratio for all the other cancers taken together was close to the null (ORQ5vs<Q5 0.99 (95% CI 0.94, 1.04)). CONCLUSION Living in the most deprived areas was inversely associated with the risk of ALL in childhood. There was no indication that the risk of childhood cancer of any site could be increased by deprivation. Life style or environmental factors potentially underlying the association need further investigation.
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Affiliation(s)
- Fabienne Marquant
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Stéphanie Goujon
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France.,French National Registry of Childhood Haematological Malignancies (NRCH), Villejuif, France
| | - Laure Faure
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France.,French National Registry of Childhood Haematological Malignancies (NRCH), Villejuif, France
| | - Sandra Guissou
- French National Registry of Childhood Solid Tumours (NRCST), Vandoeuvre-les-Nancy, France
| | - Laurent Orsi
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Denis Hémon
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Brigitte Lacour
- French National Registry of Childhood Solid Tumours (NRCST), Vandoeuvre-les-Nancy, France
| | - Jacqueline Clavel
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France.,French National Registry of Childhood Haematological Malignancies (NRCH), Villejuif, France
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12
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Bailey HD, Armstrong BK, Milne E, Schüz J, Clavel J. Comment on: The Associations Between Maternal Factors During Pregnancy and the Risk of Childhood Acute Lymphoblastic Leukemia: A Meta-Analysis. Pediatr Blood Cancer 2016; 63:951-2. [PMID: 26945804 DOI: 10.1002/pbc.25717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Helen D Bailey
- Institut National de la Santé (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
| | - Bruce K Armstrong
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
- Sax Institute, Ultimo, New South Wales, Australia
| | - Elizabeth Milne
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC), Section of Environment and Radiation, Lyon, France
| | - Jacqueline Clavel
- Institut National de la Santé (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
- RNCE-National Registry of Childhood Cancers, Villejuif, France
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Adam M, Kuehni CE, Spoerri A, Schmidlin K, Gumy-Pause F, Brazzola P, Probst-Hensch N, Zwahlen M. Socioeconomic Status and Childhood Leukemia Incidence in Switzerland. Front Oncol 2015; 5:139. [PMID: 26175964 PMCID: PMC4485172 DOI: 10.3389/fonc.2015.00139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/02/2015] [Indexed: 11/21/2022] Open
Abstract
Socioeconomic status (SES) discrepancies exist for child and adult cancer morbidity and are a major public health concern. In this Swiss population-based matched case–control study on the etiology of childhood leukemia, we selected the cases from the Swiss Childhood Cancer Registry diagnosed since 1991 and the controls randomly from census. We assigned eight controls per case from the 1990 and 2000 census and matched them by the year of birth and gender. SES information for both cases and controls was obtained from census records by probabilistic record linkage. We investigated the association of SES with childhood leukemia in Switzerland, and explored whether it varied with different definitions of socioeconomic status (parental education, living condition, area-based SES), time period, and age. In conditional logistic regression analyses of 565 leukemia cases and 4433 controls, we found no consistent evidence for an association between SES and childhood leukemia. The odds ratio comparing the highest with the lowest SES category ranged from 0.95 (95% CI: 0.71–1.26; Ptrend = 0.73) for paternal education to 1.37 (1.00–1.89; Ptrend = 0.064) for maternal education. No effect modification was found for time period and age at diagnosis. Based on this population-based study, which avoided participation and reporting bias, we assume the potential association of socioeconomic status and childhood leukemia if existing to be small. This study did not find evidence that socioeconomic status, of Switzerland or comparable countries, is a relevant risk factor or strong confounder in etiological investigations on childhood leukemia.
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Affiliation(s)
- Martin Adam
- Swiss Tropical and Public Health Institute , Basel , Switzerland ; University of Basel , Basel , Switzerland ; Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Fabienne Gumy-Pause
- Haematology/Oncology Unit, Department of Paediatrics, University Hospital of Geneva , Geneva , Switzerland
| | - Pierluigi Brazzola
- Department of Paediatrics, Ospedale San Giovanni , Bellinzona , Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute , Basel , Switzerland ; University of Basel , Basel , Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
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Del Risco Kollerud R, Blaasaas KG, Claussen B. Poverty and the risk of leukemia and cancer in the central nervous system in children: A cohort study in a high-income country. Scand J Public Health 2015; 43:736-43. [PMID: 26088131 DOI: 10.1177/1403494815590499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2015] [Indexed: 01/06/2023]
Abstract
AIMS The association between childhood cancer and socioeconomic status is inconclusive. Family income has seldom been included in large population-based studies, and the specific contributions of it remain unknown. METHODS A total of 712,674 children born between 1967 and 2009 in the Oslo region were included. Of these, 864 were diagnosed with leukemia or cancer in the central nervous system before the age of 15 years. The association between poverty and childhood leukemia or brain cancer was analyzed using logistic regression and Cox proportional hazards models. Family income was stratified according to poverty lines. Parents' educational level and several perinatal variables were also examined. RESULTS Family poverty during the first 2 years of life was associated with lymphoid leukemia before the age of 15 years: odds ratio 1.72, 95% confidence interval 1.11-2.64. In the same age group we found a significant dose response, with a 21% increased risk of lymphoid leukemia with increasing poverty. The risk for intracranial and intraspinal embryonal tumors in the whole study period was lower for children in the middle family income category. For astrocytomas there was a more than 70% increased risk in the medium income category when analyzing the two first years of life. The observed increase was reduced when all years each child contributed to the study were included. The risk of cancer in the central nervous system overall was 20% higher in the medium income category compared to the high-income category. CONCLUSIONS Being born into a household of low family income the first 2 years of life was found to be a risk factor for development of lymphoid leukemia. For astrocytomas we observed an increased risk among children born into the medium income category throughout the first two years of life.
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15
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Prescription drug use during pregnancy and risk of childhood cancer – Is there an association? Cancer Epidemiol 2015; 39:73-8. [DOI: 10.1016/j.canep.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022]
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16
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Metayer C, Milne E, Clavel J, Infante-Rivard C, Petridou E, Taylor M, Schüz J, Spector LG, Dockerty JD, Magnani C, Pombo-de-Oliveira MS, Sinnett D, Murphy M, Roman E, Monge P, Ezzat S, Mueller BA, Scheurer ME, Armstrong BK, Birch J, Kaatsch P, Koifman S, Lightfoot T, Bhatti P, Bondy ML, Rudant J, O'Neill K, Miligi L, Dessypris N, Kang AY, Buffler PA. The Childhood Leukemia International Consortium. Cancer Epidemiol 2013; 37:336-47. [PMID: 23403126 DOI: 10.1016/j.canep.2012.12.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/17/2012] [Accepted: 12/29/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acute leukemia is the most common cancer in children under 15 years of age; 80% are acute lymphoblastic leukemia (ALL) and 17% are acute myeloid leukemia (AML). Childhood leukemia shows further diversity based on cytogenetic and molecular characteristics, which may relate to distinct etiologies. Case-control studies conducted worldwide, particularly of ALL, have collected a wealth of data on potential risk factors and in some studies, biospecimens. There is growing evidence for the role of infectious/immunologic factors, fetal growth, and several environmental factors in the etiology of childhood ALL. The risk of childhood leukemia, like other complex diseases, is likely to be influenced both by independent and interactive effects of genes and environmental exposures. While some studies have analyzed the role of genetic variants, few have been sufficiently powered to investigate gene-environment interactions. OBJECTIVES The Childhood Leukemia International Consortium (CLIC) was established in 2007 to promote investigations of rarer exposures, gene-environment interactions and subtype-specific associations through the pooling of data from independent studies. METHODS By September 2012, CLIC included 22 studies (recruitment period: 1962-present) from 12 countries, totaling approximately 31000 cases and 50000 controls. Of these, 19 case-control studies have collected detailed epidemiologic data, and DNA samples have been collected from children and child-parent trios in 15 and 13 of these studies, respectively. Two registry-based studies and one study comprising hospital records routinely obtained at birth and/or diagnosis have limited interview data or biospecimens. CONCLUSIONS CLIC provides a unique opportunity to fill gaps in knowledge about the role of environmental and genetic risk factors, critical windows of exposure, the effects of gene-environment interactions and associations among specific leukemia subtypes in different ethnic groups.
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Affiliation(s)
- Catherine Metayer
- University of California, Berkeley, School of Public Health, 1995 University Avenue, Suite 460, Berkeley, CA 94704-1070, USA.
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Case-control study of paternal occupation and childhood leukaemia in Great Britain, 1962-2006. Br J Cancer 2012; 107:1652-9. [PMID: 22968649 PMCID: PMC3493752 DOI: 10.1038/bjc.2012.359] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Paternal occupational exposures have been proposed as a risk factor for childhood leukaemia. This study investigates possible associations between paternal occupational exposure and childhood leukaemia in Great Britain. Methods: The National Registry of Childhood Tumours provided all cases of childhood leukaemia born and diagnosed in Great Britain between 1962 and 2006. Controls were matched on sex, period of birth and birth registration subdistrict. Fathers’ occupations were assigned to 1 or more of 33 exposure groups. Social class was derived from father’s occupation at the time of the child’s birth. Results: A total of 16 764 cases of childhood leukaemia were ascertained. One exposure group, paternal social contact, was associated with total childhood leukaemia (odds ratio 1.14, 1.05–1.23); this association remained significant when adjusted for social class. The subtypes lymphoid leukaemia (LL) and acute myeloid leukaemia showed increased risk with paternal exposure to social contact before adjustment for social class. Risk of other leukaemias was significantly increased by exposure to electromagnetic fields, persisting after adjustment for social class. For total leukaemia, the risks for exposure to lead and exhaust fumes were significantly <1. Occupationally derived social class was associated with risk of LL, with the risk being increased in the higher social classes. Conclusion: Our results showed some support for a positive association between childhood leukaemia risk and paternal occupation involving social contact. Additionally, LL risk increased with higher paternal occupational social class.
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18
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Crouch S, Lightfoot T, Simpson J, Smith A, Ansell P, Roman E. Infectious illness in children subsequently diagnosed with acute lymphoblastic leukemia: modeling the trends from birth to diagnosis. Am J Epidemiol 2012; 176:402-8. [PMID: 22899827 DOI: 10.1093/aje/kws180] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although there is increasing evidence that immune dysregulation in children who develop acute lymphoblastic leukemia (ALL) is detectable from birth, debate about the role of infectious exposures in infancy continues. With the aim of quantifying children's infectious exposures, investigators have used a number of infection exposure proxies, but there is a lack of consistency in findings, with some markers indicating increased ALL risks and others decreased risks, the disparity being evident both within and between studies. Accordingly, the authors conducted an in-depth analysis of key infection exposure proxies used in the United Kingdom Childhood Cancer Study, a national population-based case-control study conducted over the period 1991-1996, which combined data from medical records, parental interview, and population census. This longitudinal approach revealed the marked deterioration in immune response that emerged around 5 months prior to ALL diagnosis and confirmed that infectious diagnoses in the first year of life were significantly increased (P < 0.05) in children who developed leukemia between 2 and 14 years of age, as well as in those who had birth orders >1, were not breastfed, lived in deprived areas, or were diagnosed with eczema. By contrast, no association between infectious illness and preschool activity was detected, the lower infection levels among controls whose mothers reported attendance contributing to a significantly reduced ALL odds ratio.
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Affiliation(s)
- Simon Crouch
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, United Kingdom.
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Kroll ME, Carpenter LM, Murphy MFG, Stiller CA. Effects of changes in diagnosis and registration on time trends in recorded childhood cancer incidence in Great Britain. Br J Cancer 2012; 107:1159-62. [PMID: 22898786 PMCID: PMC3461151 DOI: 10.1038/bjc.2012.296] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Increases in recorded childhood cancer incidence are widely reported, but do not necessarily represent real increases in risk. Time trends might conceal underlying steps caused by changes in diagnosis and registration procedures. METHODS Using records from the National Registry of Childhood Tumours 1966-2005 (N=54650), the age-sex-standardised rate for residents of Great Britain aged under 15 years was calculated by individual year of diagnosis for each cancer subtype, and the average annual percentage change (trend) was assessed. The timing of assumed step changes in rate was estimated by iterative Poisson regression, and compared graphically with the approximate timing of innovations previously identified from published sources. RESULTS Estimated timing of underlying steps approximately coincided with the following relevant innovations: biochemical assays, mid-1980s (hepatic and germ-cell cancer); diagnostic imaging, mid-1980s to early 1990s (intracranial/intraspinal tumours, neuroblastoma, soft-tissue sarcoma); revised cancer registration scheme, 1971 (leukaemia, bone and soft-tissue sarcoma); mandatory registration, 1993 (intracranial/intraspinal tumours, retinoblastoma, melanoma/carcinoma); cancer registration improvements, 2001 (leukaemia, renal and hepatic cancer). CONCLUSION While the possibility of some real change in risk cannot be excluded, for many cancer subtypes the estimated timing of underlying step changes in rate appeared to correspond with changes in diagnosis or registration procedures. Childhood cancer may have been considerably under-recorded in the past.
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Affiliation(s)
- M E Kroll
- Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford OX3 7LG, UK.
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20
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Reply to: ‘Childhood leukaemia and socioeconomic status in England and Wales 1976–2005: evidence of higher incidence in relatively affluent communities persists over time’. Br J Cancer 2012. [PMCID: PMC3389400 DOI: 10.1038/bjc.2012.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Comment on ‘Childhood leukaemia and socioeconomic status in England and Wales 1976–2005: evidence of higher incidence in relatively affluent communities persists over time’. Br J Cancer 2012; 107:217-8 author reply 219-20. [PMID: 22691973 PMCID: PMC3389399 DOI: 10.1038/bjc.2012.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Brown D, Benzeval M, Gayle V, Macintyre S, O'Reilly D, Leyland AH. Childhood residential mobility and health in late adolescence and adulthood: findings from the West of Scotland Twenty-07 Study. J Epidemiol Community Health 2012; 66:942-50. [PMID: 22315239 PMCID: PMC3433221 DOI: 10.1136/jech-2011-200316] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The relationship between childhood residential mobility and health in the UK is not well established; however, research elsewhere suggests that frequent childhood moves may be associated with poorer health outcomes and behaviours. The aim of this paper was to compare people in the West of Scotland who were residentially stable in childhood with those who had moved in terms of a range of health measures. Methods A total of 850 respondents, followed-up for a period of 20 years, were included in this analysis. Childhood residential mobility was derived from the number of addresses lived at between birth and age 18. Multilevel regression was used to investigate the relationship between childhood residential mobility and health in late adolescence (age 18) and adulthood (age 36), accounting for socio-demographic characteristics and frequency of school moves. The authors examined physical health measures, overall health, psychological distress and health behaviours. Results Twenty per cent of respondents remained stable during childhood, 59% moved one to two times and 21% moved at least three times. For most health measures (except physical health), there was an increased risk of poor health that remained elevated for frequent movers after adjustment for socio-demographic characteristics and school moves (but was only significant for illegal drug use). Conclusions Risk of poor health was elevated in adolescence and adulthood with increased residential mobility in childhood, after adjusting for socio-demographic characteristics and school moves. This was true for overall health, psychological distress and health behaviours, but physical health measures were not associated with childhood mobility.
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Affiliation(s)
- D Brown
- MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK.
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23
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Comparison of racial differences in childhood cancer risk in case-control studies and population-based cancer registries. Cancer Epidemiol 2012; 36:36-44. [DOI: 10.1016/j.canep.2011.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 04/05/2011] [Accepted: 05/06/2011] [Indexed: 11/19/2022]
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Tunstall H, Cabieses B, Shaw R. The characteristics of mobile families with young children in England and the impact of their moves on neighbourhood inequalities in maternal and child health. Health Place 2012; 18:657-70. [PMID: 22361636 DOI: 10.1016/j.healthplace.2011.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 11/10/2011] [Accepted: 11/27/2011] [Indexed: 11/18/2022]
Abstract
This study compares the health and socio-demographic characteristics of residentially mobile families with young children in England to families that do not move and assesses the impact of their moves upon inequalities in health between neighbourhoods. The analysis uses data from the first two waves of the Millennium Cohort Study describing 9022 cohort members, born in 2000-2002, and their families. A third of the families moved between the waves of the survey when the children were aged nine months and three years. Mobile families moved disproportionately toward less deprived areas but had disadvantaged socio-economic characteristics and poor outcomes for infant's birth weight and accidents and mother's self-rated health, limiting longstanding illness and mental health. Health outcomes were worst among the minority moving to more deprived neighbourhoods. Families' moves moderately increased health inequalities between neighbourhoods with high and low deprivation.
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Affiliation(s)
- Helena Tunstall
- University of York, Department of Health Sciences, York YO10 5DD, UK.
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Lightfoot T, Johnston W, Simpson J, Smith A, Ansell P, Crouch S, Roman E, Kinsey S. Survival from childhood acute lymphoblastic leukaemia: the impact of social inequality in the United Kingdom. Eur J Cancer 2012; 48:263-9. [DOI: 10.1016/j.ejca.2011.10.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/04/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
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Childhood leukaemia and socioeconomic status in England and Wales 1976-2005: evidence of higher incidence in relatively affluent communities persists over time. Br J Cancer 2011; 105:1783-7. [PMID: 22027710 PMCID: PMC3242592 DOI: 10.1038/bjc.2011.415] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Record-based studies have generally reported association of higher childhood leukaemia incidence with higher socioeconomic status (SES), but recent findings are less consistent. METHODS We examined records from the National Registry of Childhood Tumours for evidence of this association in England and Wales during 1976-2005. All eligible leukaemia registrations (N=11940) were grouped by year of diagnosis in decades centred on census years 1981, 1991 and 2001 (N=3748, 3922, 4270, respectively). Using data from the census appropriate to the decade, SES for each case was measured by the child-population-weighted quintile of the Carstairs deprivation index of the census ward containing the address at diagnosis. RESULTS In each decade, the age-standardised leukaemia rate in the poorest quintile was ∼90% of the rate in the most affluent. Using Poisson regression, the age-adjusted rate ratio per quintile decrease in SES was 0.96 (95% confidence interval 0.94-0.98; P<0.001 for trend) in 1976-1985, 0.97 (0.95-0.99; P=0.008) in 1986-1995 and 0.97 (0.95-0.99; P=0.009) in 1996-2005. Similar association was evident for lymphoid leukaemia, the major subgroup (N=9588 in total), but not for acute myeloid (N=1868) or other/unspecified leukaemia (N=484). CONCLUSION Reported childhood leukaemia incidence in England and Wales continues to be higher in relatively affluent communities. Possible explanations include under-diagnosis of leukaemia in children from poorer communities, and/or association of higher SES with hypothesised risk factors, such as population mixing and delayed exposure to infection.
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Grulich AE, Vajdic CM, Falster MO, Kane E, Smedby KE, Bracci PM, de Sanjose S, Becker N, Turner J, Martinez-Maza O, Melbye M, Engels EA, Vineis P, Costantini AS, Holly EA, Spinelli JJ, La Vecchia C, Zheng T, Chiu BCH, Franceschi S, Cocco P, Maynadié M, Foretova L, Staines A, Brennan P, Davis S, Severson RK, Cerhan JR, Breen EC, Birmann B, Cozen W. Birth order and risk of non-hodgkin lymphoma--true association or bias? Am J Epidemiol 2010; 172:621-30. [PMID: 20720098 PMCID: PMC2950815 DOI: 10.1093/aje/kwq167] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/10/2010] [Indexed: 12/22/2022] Open
Abstract
There is inconsistent evidence that increasing birth order may be associated with risk of non-Hodgkin lymphoma (NHL). The authors examined the association between birth order and related variables and NHL risk in a pooled analysis (1983-2005) of 13,535 cases and 16,427 controls from 18 case-control studies within the International Lymphoma Epidemiology Consortium (InterLymph). Overall, the authors found no significant association between increasing birth order and risk of NHL (P-trend = 0.082) and significant heterogeneity. However, a significant association was present for a number of B- and T-cell NHL subtypes. There was considerable variation in the study-specific risks which was partly explained by study design and participant characteristics. In particular, a significant positive association was present in population-based studies, which had lower response rates in cases and controls, but not in hospital-based studies. A significant positive association was present in higher-socioeconomic-status (SES) participants only. Results were very similar for the related variable of sibship size. The known correlation of high birth order with low SES suggests that selection bias related to SES may be responsible for the association between birth order and NHL.
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Affiliation(s)
- Andrew E Grulich
- HIV Epidemiology and Prevention Program, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, New South Wales 2052, Australia.
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Johnston WT, Lightfoot TJ, Simpson J, Roman E. Childhood cancer survival: a report from the United Kingdom Childhood Cancer Study. Cancer Epidemiol 2010; 34:659-66. [PMID: 20674536 DOI: 10.1016/j.canep.2010.06.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 06/29/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Improvements in diagnostic approaches and refinements to treatment protocols have resulted in 5-year survival levels above 70% for children diagnosed with cancer in economically developed parts of the world. For some cancers, including leukaemia and tumours of the central nervous system, age and sex have been identified as important prognostic indicators. METHODS We examined long-term survival, and affects of age and sex, in a population-based case-control study. Children (0-14 years) newly diagnosed with cancer were ascertained between 1991 and 1996 (n=4433). Follow-up information was obtained from the National Health Service (NHS) Information Centre for Health and Social Care which records all exits from the NHS including deaths. RESULTS For all cancer diagnoses combined, 5-year survival was 72.7% dropping to 67.9% at 15 years. As expected, survival differed between diagnostic subtypes ranging from 38.1% for intracranial embryonal tumours to 96.2% for Hodgkin lymphoma. Compared to girls, boys diagnosed with acute lymphoblastic leukaemia were at a higher risk of dying (RR=1.26, 95% CI 1.03-1.53), whereas boys diagnosed with an intracranial embryonal tumour were at a lower risk of death (RR=0.63, 95% CI 0.43-0.91). CONCLUSION Our initial findings are consistent with previous reports, and highlight the importance of considering differences by age and sex. The completeness and population-based nature of the original case-control study is an important feature which will provide the basis for future more detailed investigations linking disease determinants to outcome.
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Affiliation(s)
- W Thomas Johnston
- Epidemiology and Genetics Unit, Department of Health Sciences, University of York, York, Y010 5DD, United Kingdom.
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Tunstall H, Pickett K, Johnsen S. Residential mobility in the UK during pregnancy and infancy: are pregnant women, new mothers and infants 'unhealthy migrants'? Soc Sci Med 2010; 71:786-98. [PMID: 20554366 DOI: 10.1016/j.socscimed.2010.04.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 02/04/2010] [Accepted: 04/16/2010] [Indexed: 11/18/2022]
Abstract
People that move home within developed countries report, on average, better health than non-movers. Pregnant women, new mothers and infants are particularly mobile, but the limited evidence regarding the relationship between their mobility and health suggests they may not conform to the 'healthy migrant' effect. This paper examines the relationship between mobility and health among these groups in the UK, using logistic regression to analyse cross-sectional data for 18,197 families in the Millennium Cohort Study wave one. It compares health status variables among mobile and non-mobile families; describes mobile families' socio-demographic characteristics; explores associations between health outcomes, reasons for residential moves, and experiences of homelessness; and assesses the association between mobility and health care utilisation, social support and residential satisfaction. The paper concludes that mobile pregnant women, new mothers and infants do have poor health outcomes in comparison to non-movers, but this is primarily explained by their socio-demographic characteristics and the negative circumstances associated with a minority of their moves. Families that moved during pregnancy and infancy had worse self-rated health and depression among mothers, and lower birth weight and higher risk of accidents among infants, than non-movers. Mothers in mobile families were younger and had lower levels of education and owner-occupation than non-movers. After adjustment for socio-demographic characteristics mobility was weakly and non-significantly associated with most health variables with the exception of self-rated health and depression among mothers who moved for negative reasons (such as relationship breakdown or problems with neighbours), or had been homeless since birth. After adjustment mobile families had lower levels of most measures of health care utilisation compared to non-movers, but mothers did not report less frequent social contacts, and those that moved during infancy for positive reasons (such as wanting a better home or neighbourhood) had greater satisfaction with home and area.
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Affiliation(s)
- Helena Tunstall
- Department of Health Sciences, University of York, United Kingdom.
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30
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Pan IJ, Daniels JL, Zhu K. Poverty and childhood cancer incidence in the United States. Cancer Causes Control 2010; 21:1139-45. [DOI: 10.1007/s10552-010-9528-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 02/13/2010] [Indexed: 11/29/2022]
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Morgan G, Johnsen J. Might salicylate exert benefits against childhood cancer? Ecancermedicalscience 2010; 4:156. [PMID: 22276025 PMCID: PMC3234022 DOI: 10.3332/ecancer.2010.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Indexed: 11/06/2022] Open
Abstract
Childhood cancers are a broad range of diseases. Research on the chemopreventive potential of non-steroidal anti-inflammatory drugs, such as aspirin (acetylsalicylate) has yet to be fully directed towards childhood cancers. A prima facie hypothesis on salicylate and childhood cancer would therefore be based on several factors. Firstly, salicylate inhibits the production of inflammatory prostaglandins, which have been shown to stimulate the growth of cancer cells. Secondly, salicylate inhibits the growth of cancer cells in pre-clinical models. Thirdly, salicylate is a natural component of fruits and vegetables so it is consumed within the diet. Further research, of which some possibilities are identified, is recommended.
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Affiliation(s)
- G Morgan
- Fellow of the Royal Institute for Public Health, National Health Service for Wales, Wales, UK
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Koppen IJN, Hermans FJR, Kaspers GJL. Folate related gene polymorphisms and susceptibility to develop childhood acute lymphoblastic leukaemia. Br J Haematol 2010; 148:3-14. [DOI: 10.1111/j.1365-2141.2009.07898.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smith A, Roman E, Howell D, Jones R, Patmore R, Jack A. The Haematological Malignancy Research Network (HMRN): a new information strategy for population based epidemiology and health service research. Br J Haematol 2009; 148:739-53. [PMID: 19958356 PMCID: PMC3066245 DOI: 10.1111/j.1365-2141.2009.08010.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Haematological Malignancy Research Network (HMRN) was established in 2004 to provide robust generalizable data to inform clinical practice and research. It comprises an ongoing population-based cohort of patients newly diagnosed by a single integrated haematopathology laboratory in two adjacent UK Cancer Networks (population 3·6 million). With an emphasis on primary-source data, prognostic factors, sequential treatment/response history, and socio-demographic details are recorded to clinical trial standards. Data on 8131 patients diagnosed over the 4 years 2004–08 are examined here using the latest World Health Organization classification. HMRN captures all diagnoses (adult and paediatric) and the diagnostic age ranged from 4 weeks to 99 years (median 70·4 years). In line with published estimates, first-line clinical trial entry varied widely by disease subtype and age, falling from 59·5% in those aged <15 years to 1·9% in those aged over 75 years – underscoring the need for contextual population-based treatment and response data of the type collected by HMRN. The critical importance of incorporating molecular and prognostic markers into comparative survival analyses is illustrated with reference to diffuse-large B-cell lymphoma, acute myeloid leukaemia and myeloma. With respect to aetiology, several descriptive factors are highlighted and discussed, including the unexplained male predominance evident for most subtypes across all ages.
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Geographical variation in the incidence of acute lymphoblastic leukaemia in childhood-Is it real? Cancer Epidemiol 2009; 33:401-2. [PMID: 19932647 DOI: 10.1016/j.canep.2009.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2009] [Indexed: 11/21/2022]
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Smith A, Lightfoot T, Simpson J, Roman E. Birth weight, sex and childhood cancer: A report from the United Kingdom Childhood Cancer Study. Cancer Epidemiol 2009; 33:363-7. [PMID: 19932649 DOI: 10.1016/j.canep.2009.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 10/14/2009] [Accepted: 10/22/2009] [Indexed: 11/30/2022]
Abstract
Birth weight has been linked to the risk of developing childhood cancer, in particular childhood leukaemia. However, despite many childhood cancers having a male predominance and boys generally weighing more than girls at birth few studies have reported sex-specific associations. The relationship between birth weight and childhood cancer risk was examined using information from a national case-control study. Children (0-14 years) newly diagnosed with cancer in GB were ascertained between 1991 and 1996 (n=3651) and for comparison, controls matched on sex, month and year of birth were identified from primary care population registers (n=6337). Birth weights were obtained from the Office of National Statistics for all targeted subjects born in England and Wales. Overall, cases were, on average, 30 g heavier at birth than controls (p=0.003) with differences seen by cancer type; those diagnosed with hepatic tumours weighing around 500 g less than controls at birth (p<0.0001) and those with leukaemia being, on average, 50 g heavier than those without (p=0.001). An interaction between birth weight and sex was found for acute leukaemia (chi(2)=11.2, p=0.04) and when data were stratified by sex, an association between high birth weight and risk of ALL was seen with girls (>4000 g, OR 1.86, 95% CI 1.38-2.50, chi(2) for trend 20.2, p<0.0001). Our results support the hypothesis that birth weight is an important determinant for childhood cancer. In addition, the data are consistent with the notion that childhood leukaemia has a prenatal origin.
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Affiliation(s)
- Alexandra Smith
- Epidemiology & Genetics Unit, Department of Health Sciences and Hull & York Medical School, University of York, York, UK.
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Mbulaiteye SM, Biggar RJ, Bhatia K, Linet MS, Devesa SS. Sporadic childhood Burkitt lymphoma incidence in the United States during 1992-2005. Pediatr Blood Cancer 2009; 53:366-70. [PMID: 19434731 PMCID: PMC2713377 DOI: 10.1002/pbc.22047] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The risk factors and co-factors for sporadic childhood BL are unknown. We investigated demographic and age-specific characteristics of childhood BL (0-14 years) in the U.S. PROCEDURE BL age-standardized incidence rates (2000 U.S. standard population), were calculated using data obtained from 12 registries in the NCI's Surveillance, Epidemiology, and End Results program for cases diagnosed from 1992 to 2005. Incidence rate ratios and 95% confidence intervals (95% CI) were calculated by gender, age-group, race, ethnicity, calendar-year period, and registry. RESULTS Of 296 cases identified, 56% were diagnosed in lymph nodes, 21% in abdominal organs, not including retroperitoneal lymph nodes, 14% were Burkitt cell leukemia, and 9% on face/head structures. The male-to-female case ratio was highest for facial/head tumors (25:1) and lowest for Burkitt cell leukemia (1.6:1). BL incidence rate was 2.5 (95% CI 2.3-2.8) cases per million person-years and was higher among boys than girls (3.9 vs. 1.1, P < 0.001) and higher among Whites and Asians/Pacific Islanders than among Blacks (2.8 and 2.9 vs. 1.2, respectively, P < 0.001). By ethnicity, BL incidence was higher among non-Hispanic Whites than Hispanic Whites (3.2 vs. 2.0, P = 0.002). Age-specific incidence rate for BL peaked by age 3-5 years (3.4 cases per million), then stabilized or declined with increasing age, but it did not vary with calendar-year or registry area. CONCLUSIONS Our results indicate that early childhood exposures, male-sex, and White race may be risk factors for sporadic childhood BL in the United States.
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Affiliation(s)
- Sam M Mbulaiteye
- Infections and Immunoepidemiology Branch, DCEG, National Cancer Institute, Bethesda, Maryland, USA.
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McGrath P, Phillips E. “It Is Very Hard”: Treatment for Childhood Lymphoma from the Parents' Perspective. ACTA ACUST UNITED AC 2009; 31:37-54. [DOI: 10.1080/01460860701877209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Urayama KY, Von Behren J, Reynolds P, Hertz A, Does M, Buffler PA. Factors associated with residential mobility in children with leukemia: implications for assigning exposures. Ann Epidemiol 2009; 19:834-40. [PMID: 19364662 DOI: 10.1016/j.annepidem.2009.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 02/13/2009] [Accepted: 03/03/2009] [Indexed: 01/05/2023]
Abstract
PURPOSE In epidemiologic studies, neighborhood characteristics are often assigned to individuals based on a single residence despite the fact that people frequently move and, for most cancer outcomes, the relevant time-window of exposure is not known. The authors evaluated residential mobility patterns for a population-based series of childhood leukemia cases enrolled in the Northern California Childhood Leukemia Study. METHODS Complete residential history from 1 year before birth to date of diagnosis was obtained for 380 cases diagnosed between 1995 and 2002. All residences were assigned U.S. Census block group designations using a geographic information system. RESULTS Overall, two-thirds (65.8%) of children had moved between birth and diagnosis, and one-third (34.5%) moved during the first year of life. Approximately 25% of the mothers had moved during the year before the child's birth. Multivariable analysis indicated greater residential mobility to be associated with older age of the child at diagnosis, younger age of the mother at child's birth, and lower household income. Among those who had moved, residential urban/rural status for birth and diagnosis residences changed for about 20% of subjects, and neighborhood socioeconomic status for 35%. CONCLUSIONS These results suggest that neighborhood attribute estimates in health studies should account for patterns of residential mobility. Estimates based on a single residential location at a single point in time may lead to different inferences.
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Affiliation(s)
- Kevin Y Urayama
- School of Public Health, University of California, Berkeley, CA 94704, USA.
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Infectious proxies and childhood leukaemia: Findings from the United Kingdom Childhood Cancer Study (UKCCS). Blood Cells Mol Dis 2009; 42:126-8. [DOI: 10.1016/j.bcmd.2008.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 10/18/2008] [Indexed: 11/20/2022]
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Ribeiro KB, Buffler PA, Metayer C. Socioeconomic status and childhood acute lymphocytic leukemia incidence in São Paulo, Brazil. Int J Cancer 2008; 123:1907-12. [DOI: 10.1002/ijc.23738] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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McKinney PA, Raji OY, van Tongeren M, Feltbower RG. The UK Childhood Cancer Study: maternal occupational exposures and childhood leukaemia and lymphoma. RADIATION PROTECTION DOSIMETRY 2008; 132:232-40. [PMID: 18922820 DOI: 10.1093/rpd/ncn265] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Risks of childhood leukaemia and lymphoma were investigated for specific work-related exposures of mothers in the UK Childhood Cancer Study. Interviews with parents of 1881 leukaemia and lymphoma cases (0-14 years) and 3742 controls collected job histories recording exposure to eight specific agents. Exposure was (1) self-reported and (2) reviewed, based mainly on exposure probability and exposure level. Completeness, consistency and sufficiency evaluated data quality. Of all job exposures which were self-reported as exposed, 33% cases and 34% controls remained classified as exposed after review, with the remainder designated as partially exposed or unexposed. No review of underreporting of exposure was made. Data quality was 'good' for 26% of cases and 24% of controls. For self-reported exposure, significant risks of acute lymphoblastic leukaemia (ALL) were observed for solvents and petrol in all time windows. For reviewed exposure, solvents remained significant for ALL during pregnancy and postnatally. Restricting analyses to good-quality information removed all significant results. Refinement of exposure assessment revealed misclassification of self-reported exposures and data quality influenced risk assessment. Maternal exposure to solvents should further be investigated. These findings must invoke caution in the interpretation of risks reliant on self-reported occupational data.
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Affiliation(s)
- Patricia A McKinney
- Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, Room 8.49J, Level 8, Worsley Building, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK.
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Adam M, Rebholz CE, Egger M, Zwahlen M, Kuehni CE. Childhood leukaemia and socioeconomic status: what is the evidence? RADIATION PROTECTION DOSIMETRY 2008; 132:246-54. [PMID: 18927134 DOI: 10.1093/rpd/ncn261] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The objectives of this systematic review are to summarise the current literature on socioeconomic status (SES) and the risk of childhood leukaemia, to highlight methodological problems and formulate recommendations for future research. Starting from the systematic review of Poole et al. (Socioeconomic status and childhood leukaemia: a review. Int. J. Epidemiol. 2006;35(2):370-384.), an electronic literature search was performed covering August 2002-April 2008. It showed that (1) the results are heterogeneous, with no clear evidence to support a relation between SES and childhood leukaemia; (2) a number of factors, most importantly selection bias, might explain inconsistencies between studies; (3) there is some support for an association between SES at birth (rather than later in childhood) and childhood leukaemia and (4) if there are any associations, these are weak, limited to the most extreme SES groups (the 10-20% most or least deprived). This makes it unlikely that they would act as strong confounders in research addressing associations between other exposures and childhood leukaemia. Future research should minimise case and control selection bias, distinguish between different SES measures and leukaemia subtypes and consider timing of exposures and cancer outcomes.
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Affiliation(s)
- Martin Adam
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern CH-3012, Switzerland
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Smith A, Roman E, Simpson J. Childhood leukaemia and socioeconomic status. Int J Epidemiol 2007. [DOI: 10.1093/ije/dym166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hughes AM, Lightfoot T, Simpson J, Ansell P, McKinney PA, Kinsey SE, Mitchell CD, Eden TOB, Greaves M, Roman E. Allergy and risk of childhood leukaemia: results from the UKCCS. Int J Cancer 2007; 121:819-24. [PMID: 17390373 DOI: 10.1002/ijc.22702] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the relationship between childhood leukaemia and preceding history of allergy. A nationwide case-control study of childhood cancers was conducted in the United Kingdom with population-based sampling of cases (n = 839) and controls (n = 1,337), matched on age, sex and region of residence. Information about clinically diagnosed allergies was obtained from primary care records. More than a third of subjects had at least one allergy diagnosed prior to leukaemia diagnosis (cases) or pseudo-diagnosis (controls). For both total acute lymphoblastic leukaemia (ALL) and common-ALL/precursor B-cell ALL (c-ALL), a history of eczema was associated with a 30% significant reduction in risk: the odds ratios (OR) and 95% confidence intervals (CI) were 0.70 (0.51-0.97) and 0.68 (0.48-0.98), respectively. Similar associations were observed for hayfever (OR = 0.47; 95% CI: 0.26-0.85 and OR = 0.62; 95% CI: 0.33-1.16 for ALL and c-ALL, respectively). No such patterns were seen either for asthma and ALL, or for any allergy and acute myeloid leukaemia. A comparative analysis of primary care records with parents recall of allergy revealed only moderate agreement with contemporaneous clinical diagnoses for both cases and controls--confirming the unreliability of parental report at interview. Our finding of a reciprocal relationship between allergy and ALL in children is compatible with the hypothesis that a dysregulated immune response is a critical determinant of childhood ALL.
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Affiliation(s)
- Ann M Hughes
- Epidemiology and Genetics Unit, Department of Health Sciences, University of York, York, United Kingdom
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Simpson J, Smith A, Ansell P, Roman E. Childhood leukaemia and infectious exposure: a report from the United Kingdom Childhood Cancer Study (UKCCS). Eur J Cancer 2007; 43:2396-403. [PMID: 17826085 DOI: 10.1016/j.ejca.2007.07.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 07/24/2007] [Accepted: 07/31/2007] [Indexed: 12/01/2022]
Abstract
Data from a national case-control study are used to explore the relationships between childhood leukaemia, infant infection and three markers of infectious exposure - birth order, infant-activity group attendance and area-based deprivation. Amongst controls, clinically diagnosed infection in the first year varied little with birth order and infant-activity group attendance - with 4 in 5 children having at least one infection, and each child averaging around 2.9 (2.8-3.0). Amongst cases of acute lymphoblastic leukaemia (ALL), the levels of infection increased as the indices of infectious exposure increased - for example, odds ratios associated with at least one infection in the first year being 0.9 (95% confidence interval (CI): 0.6-1.4) for birth order one and 1.6 (95% CI: 1.1-2.2) for birth order two or more. By contrast, interview data were misleading, with mothers - particularly case mothers - consistently under-reporting. We conclude that the findings based on clinical data, combined with the markers of infectious exposure, confirm the observation that immune dysregulation among children who develop ALL is detectable from an early age.
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Affiliation(s)
- Jill Simpson
- Department of Health Sciences, University of York, YO10 5DD, UK.
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Borugian MJ, Spinelli JJ, Mezei G, Wilkins R, McBride M. Childhood leukaemia and socioeconomic status. Int J Epidemiol 2007; 36:929. [PMID: 17670774 DOI: 10.1093/ije/dym061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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