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Morales-Suárez-Varela M, Llopis-Morales A, Doccioli C, Donzelli G. Relationship between parental exposure to radiofrequency electromagnetic fields and primarily hematopoietic neoplasms (lymphoma, leukemia) and tumors in the central nervous system in children: a systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:499-510. [PMID: 36944196 DOI: 10.1515/reveh-2022-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Low-frequency electromagnetic fields have grown exponentially in recent years due to technological development and modernization. The World Health Organization (WHO)/International Agency for Research on Cancer (IARC) has classified radiofrequency electromagnetic fields (RF-EMFs) as possibly carcinogenic to humans (Group 2B), and recent studies have investigated the association between exposure to electromagnetic fields in parents and possible health effects in children, especially the development of tumours of the central nervous system (CNS). The objective of this systematic review was to collate all evidence on the relationship between parental occupational exposure to electromagnetic fields and the development of CNS cancer in children and to evaluate this association. This review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched from January 1990 to April 2021. The search was conducted using the following search string: "occupational" AND "child" AND "electromagnetic" AND "cancer". Seventeen articles met our inclusion criteria: 13 case-control studies, two cohort studies, and 2 meta-analyses. Most of the studies showed several methodological weaknesses that limited their results. Due to a lack of consistency regarding the outcome as well as the heterogeneity in the reviewed studies, the body of evidence for the effects of parental exposure to electromagnetic fields is not clear. Methodological heterogeneity in the way that studies were conducted could be responsible for the lack of consistency in the findings. Overall, the body of evidence allows no conclusion on the relationship between parental exposure to electromagnetic fields and the occurrence of CNS tumours in children.
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Affiliation(s)
- María Morales-Suárez-Varela
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology, and Legal Medicine, School of Pharmacy, University of Valencia, Avenida Vicente Andres Estellés s/n, Burjassot, 46100 Valencia, Spain
- CIBER of Epidemiology and Public Health (CIBERESP). Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid
| | - Agustin Llopis-Morales
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology, and Legal Medicine, School of Pharmacy, University of Valencia, Avenida Vicente Andres Estellés s/n, Burjassot, 46100 Valencia, Spain
| | - Chiara Doccioli
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Gabriele Donzelli
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy
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Wellbrock M, Voigt M, Ronckers C, Grabow D, Spix C, Erdmann F. Registration, incidence patterns, and survival trends of central nervous system tumors among children in Germany 1980-2019: An analysis of 40 years based on data from the German Childhood Cancer Registry. Pediatr Blood Cancer 2024; 71:e30954. [PMID: 38532243 DOI: 10.1002/pbc.30954] [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: 12/18/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Tumors of the central nervous system (CNS) are the second most common type of pediatric cancer in Germany. We aimed to describe registration practice, incidence, and survival patterns for childhood CNS tumors in Germany for the past 40 years. PROCEDURE Including all CNS tumor cases in children diagnosed at ages 0-14 years registered at the German Childhood Cancer Registry (GCCR) in 1980-2019 (for survival analysis 1980-2016), we calculated age-specific and age-standardized incidence rates (ASIR) over time, average annual percentage changes (AAPC), and 1- and 5-year overall survival. RESULTS While we observed a pronounced increase in ASIR after the establishment of the GCCR during the 1980s, ASIR for all pediatric CNS tumors combined continued to increase markedly from 28.6 per million in 1990-1999 to 43.3 in 2010-2019 (AAPC = 2.7% in 1991-2010, AAPC = 0.3% in 2010-2019). The 5-year overall survival from CNS tumors improved from 63% in the 1980s, 70% in the 1990s to 79% in 2010-2016. These improvements have occurred across all age groups. Children diagnosed with ependymomas and choroid plexus tumors experienced the strongest increase (from 54% to 81%). CONCLUSIONS Observed increases in incidence rates for pediatric CNS tumors are likely only partially caused by actual increasing case numbers. The majority is a function of improved registration and, to a minor extent, improvements in diagnostics. Survival from pediatric CNS tumors has, by and large, improved consistently, leading to a growing population of childhood cancer survivors with diverse health biographies and risk of lifelong adverse impact on health and wellbeing.
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Affiliation(s)
- Maike Wellbrock
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Mathias Voigt
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Cecile Ronckers
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friederike Erdmann
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Zahid N, Enam SA, Urooj F, Martins RS, Mårtensson T, Mårtensson A, Mushtaq N, Kausar F, Moochhala M, Mughal MN, Altaf S, Kirmani S, Brown N. Socio-demographic and antenatal risk factors of brain tumor in children and young people: A matched case-control study from Karachi, Pakistan. J Public Health Res 2023; 12:22799036231197185. [PMID: 37700932 PMCID: PMC10493064 DOI: 10.1177/22799036231197185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023] Open
Abstract
Background Brain tumors are a common cause of morbidity, disability, cognitive deterioration and mortality in children, even after treatment. Little is know about the specific causes. The study aimed to assess potential socio-demographic and antenatal factors in primary brain tumor (PBTs) in children and young people (CYP) in Karachi, Pakistan. Designs and methods A single center hospital based matched case control study in Karachi, Pakistan. Cases were defined as CYP aged between 5 and 21 years with any histological type and grade of primary brain tumor of any histology, stage or grade. Data were collected from parents of 244 patients at the selected center between 2017 and 2021 via telephonic interview. Controls were 5-21 years old CYP admitted with non-oncological diagnoses matched on age and sex. Matched Odds Ratios for predictors of brain tumor in children were derived. Those of statistical significance were included in a multivariable logistic regression model. Results In the adjusted model, lower paternal education (matched adjusted odds ratio (maOR) 2.46; 95% CI 1.09-5.55), higher household monthly income (maOR 3.4; 95% CI 1.1-10.2), antenatal paternal use of addictive substances (maOR 19.5; 95% CI 2.1-179.8), and antenatal maternal use of analgesics during pregnancy (maOR 3.0; 95% CI 1.2-7.9) were all independently predictive of brain tumors. Conclusion This matched case-control study found novel associations between maternal use of analgesics, paternal use of addictive substances, higher household income, and lower paternal education and Primary Brain Tumors in Children and Young People. Longitudinal multicenter studies will be required to test these associations prospectively.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Faiza Urooj
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Russell Seth Martins
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Naureen Mushtaq
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Faiza Kausar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Mariya Moochhala
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Sadaf Altaf
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
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Huang J, Li H, Yan H, Li FX, Tang M, Lu DL. The comparative burden of brain and central nervous system cancers from 1990 to 2019 between China and the United States and predicting the future burden. Front Public Health 2022; 10:1018836. [PMID: 36339132 PMCID: PMC9635888 DOI: 10.3389/fpubh.2022.1018836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
Background Brain and central nervous system (CNS) cancers represent a major source of cancer burden in China and the United States. Comparing the two countries' epidemiological features for brain and CNS cancers can help plan interventions and draw lessons. Methods Data were extracted from the Global Burden of Disease repository. The average annual percentage change (AAPC) and relative risks of cancer burdens were calculated using joinpoint regression analysis and age-period-cohort (APC) models, respectively. Moreover, a Bayesian APC model was employed to predict the disease burden over the next decade. Results From 1990 to 2019, the number of incidences, deaths, and disability-adjusted life-years (DALYs) increased in China and the US, with a larger increase in China. Age-standardized incidence rates in China and the United States have shown an increasing trend over the past three decades, with AAPCs of 0.84 and 0.16%, respectively. However, the rates of age-standardized mortality and age-standardized DALYs decreased in both countries, with a greater decrease in China. Overall, age trends in cancer burden were similar for males and females, with two peaks in the childhood and elderly groups, respectively. The period and cohort effects on incidence showed an overall increasing trend in China and limited change in the US. However, the period effects for mortality and DALY were decreasing in both countries, while the cohort effects tended to increase and then decrease. Moreover, we predicted that the cancer burdens would continue to rise in China over the next decade. Conclusion The burden of brain and CNS cancers is substantial and will continue to increase in China. Comprehensive policy and control measures need to be implemented to reduce the burden.
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Affiliation(s)
| | | | | | | | | | - Da-Lin Lu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
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Environmental Risk Factors for Childhood Central Nervous System Tumors: an Umbrella Review. CURR EPIDEMIOL REP 2022. [DOI: 10.1007/s40471-022-00309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Buser JM, Lake K, Ginier E. Environmental Risk Factors for Childhood Cancer in an Era of Global Climate Change: A Scoping Review. J Pediatr Health Care 2022; 36:46-56. [PMID: 34134914 DOI: 10.1016/j.pedhc.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/19/2021] [Accepted: 05/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contemporary research about environmental risk factors in an era of global climate change to inform childhood cancer prevention efforts is disjointed. Planetary pediatric providers need to establish a better understanding of how the postnatal environment influences childhood cancer. Authors conducted a scoping review of recent scientific literature with the aim of understanding the environmental risk factors for childhood cancer. METHOD Ovid Medline, CINAHL, and Scopus databases were searched with results limited to the English language with publication years 2010-2021. Two independent reviewers screened 771 abstracts and excluded 659 abstracts and 65 full-text articles on the basis of predefinedcriteria. RESULTS The scoping review identified 47 studies about environmental risk factors for childhood cancer with mixed results and limited consensus in four main categories, including air pollution, chemical exposures, radiation, and residential location. DISCUSSION Research by collaborative international groups of planetary health researchers about environmental risk factors is needed to inform global health policy for childhood cancer prevention efforts.
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Zhu B, Wu X, Piao H, Xu S, Yao B. A Comparison of Epidemiological Characteristics of Central Nervous System Tumours in China and Globally from 1990 to 2019. Neuroepidemiology 2021; 55:460-472. [PMID: 34781283 DOI: 10.1159/000519463] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite their great disease burden, there have been few studies on the epidemiology of central nervous system tumours (CNSTs) in China. We used the latest data updated by GBD to analyse the trends of incidence, mortality, and disability-adjusted life years (DALYs) for CNSTs in China versus globally. METHODS Epidemiological data on CNSTs were extracted from GBD 2019. We used Joinpoint regression analysis to calculate the magnitude and direction of the trends and the age-period-cohort method to analyse the age, period, and cohort effects of the trend. RESULTS From 1990 to 2019, the 106.52% increase in Chinese incident cases was higher than the global increase (94.35%). The 67.32% increase in cancer deaths and 16.03% increase in DALYs were lower than the global increases (cancer death: 76.36%; DALYs: 40.06%). The age-standardized incidence rates (ASIRs) in China were higher than the global ASIRs, and the increase in China was higher than that globally. Although the age-standardized mortality rates and age-standardized DALY rates in China were higher, their increases in China were less than those globally. Both in China and globally, the number and incidence, mortality, and DALYs by age group showed a bimodal distribution (younger than 5 years and older), and the peak in the older age group showed a backwards trend. The proportion of incident cases, cancer deaths, and DALYs also increased in the older age group. In the age-period-cohort model, the local drifts in the older age group were above zero. CONCLUSIONS The burden of CNSTs is very serious in China, and we should pay attention to the key populations, early diagnosis technology, improvements in medical technology, and ways to reduce medical costs. We believe our results could help policymakers allocate resources efficiently to reduce the burden of CNSTs.
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Affiliation(s)
- Bo Zhu
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Haozhe Piao
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Shuang Xu
- Library of China Medical University, Shenyang, China
| | - Bing Yao
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
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Mbi Feh MKN, Lyon KA, Brahmaroutu AV, Tadipatri R, Fonkem E. The need for a central brain tumor registry in Africa: A review of central nervous system tumors in Africa from 1960 to 2017. Neurooncol Pract 2021; 8:337-344. [PMID: 34055381 DOI: 10.1093/nop/npaa086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Central nervous system (CNS) tumors pose a substantial health problem. Although data on specific time periods and regions of Africa have been previously reported, no study has yet to provide a systematic review of CNS tumors for the entire continent of Africa. This study aims to analyze the frequency of CNS tumors in Africa from 1960 to 2017. Methods A comprehensive literature search on CNS tumors in Africa was performed using multiple online scientific databases. The following keywords were queried in combination with the phrase "CNS tumors in Africa": incidence, frequency, epidemiology, prevalence, brain, and cancer. A total of 26 articles met the inclusion criteria. Each selected article reported incidence and mortality rates from different regions of Africa in a time period between 1960 and 2017. SPSS21 statistical software was used to analyze the data. Results Nigeria, Egypt, and Uganda were found to have the most of the cases of CNS tumors in Africa. Males made up 54% of the 5902 cases per 100 000 population. The most common CNS tumors found were astrocytoma (24.70%), meningioma (22.22%), pituitary adenoma (8.4%), medulloblastoma (4.26%), craniopharyngioma (4.07%), and other not specified (25.17%). Conclusions Given the large population of Africa, the total reported cases may be underestimated when compared with other continents due to the lack of a central brain tumor registry in Africa. A comprehensive knowledge of CNS tumors in Africa is critical to population-based research and improving the current healthcare system.
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Affiliation(s)
| | - Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA
| | | | - Ramya Tadipatri
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ekokobe Fonkem
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
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Erdmann F, Hvidtfeldt UA, Sørensen M, Raaschou-Nielsen O. Socioeconomic differences in the risk of childhood central nervous system tumors in Denmark: a nationwide register-based case-control study. Cancer Causes Control 2020; 31:915-929. [PMID: 32767157 PMCID: PMC7458950 DOI: 10.1007/s10552-020-01332-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Differences in the risk of childhood central nervous system (CNS) tumors by socioeconomic status (SES) may enhance etiologic insights. We conducted a nationwide register-based case-control study to evaluate socioeconomic differences in the risk of childhood CNS tumors in Denmark and examined whether associations varied by different SES measures, time points of assessment, specific tumor types, and age at diagnosis. METHODS We identified all children born between 1981 and 2013 and diagnosed with a CNS tumor at ages 0-19 years (n = 1,273) from the Danish Cancer Registry and sampled four individually matched controls per case (n = 5,086). We used conditional logistic regression models to estimate associations with individual-level and neighborhood-level socioeconomic measures. RESULTS We observed elevated risks of ependymoma and embryonal CNS tumors in association with higher parental education (odds ratios (ORs) of 1.6-2.1 for maternal or paternal high education and ependymoma) and higher risk of all tumor types in association with higher maternal income, e.g., OR 1.93; 95% CI 1.05-3.52 for high versus low income for astrocytoma and other gliomas. Associations were often stronger in children diagnosed at ages 5-19 years. We found little evidence for an association with neighborhood SES. CONCLUSION This large nationwide register study with minimal risk of bias showed that having parents with higher educational level and a mother with higher income was associated with a higher risk of childhood CNS tumors. Bias or under-ascertainment of cases among families with low income or basic education is unlikely to explain our findings.
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Affiliation(s)
- Friederike Erdmann
- Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen, Denmark.
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany.
| | - Ulla Arthur Hvidtfeldt
- Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Universitetsvej 1, P.O. Box 260, 4000, Roskilde, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O. Box 358, 4000, Roskilde, Denmark
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Konstantinoudis G, Schuhmacher D, Ammann RA, Diesch T, Kuehni CE, Spycher BD. Bayesian spatial modelling of childhood cancer incidence in Switzerland using exact point data: a nationwide study during 1985-2015. Int J Health Geogr 2020; 19:15. [PMID: 32303231 PMCID: PMC7165384 DOI: 10.1186/s12942-020-00211-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aetiology of most childhood cancers is largely unknown. Spatially varying environmental factors such as traffic-related air pollution, background radiation and agricultural pesticides might contribute to the development of childhood cancer. This study is the first investigation of the spatial disease mapping of childhood cancers using exact geocodes of place of residence. METHODS We included 5947 children diagnosed with cancer in Switzerland during 1985-2015 at 0-15 years of age from the Swiss Childhood Cancer Registry. We modelled cancer risk using log-Gaussian Cox processes and indirect standardisation to adjust for age and year of diagnosis. We examined whether the spatial variation of risk can be explained by modelled ambient air concentration of NO2, modelled exposure to background ionising radiation, area-based socio-economic position (SEP), linguistic region, duration in years of general cancer registration in the canton or degree of urbanisation. RESULTS For all childhood cancers combined, the posterior median relative risk (RR), compared to the national level, varied by location from 0.83 to 1.13 (min to max). Corresponding ranges were 0.96 to 1.09 for leukaemia, 0.90 to 1.13 for lymphoma, and 0.82 to 1.23 for central nervous system (CNS) tumours. The covariates considered explained 72% of the observed spatial variation for all cancers, 81% for leukaemia, 82% for lymphoma and 64% for CNS tumours. There was weak evidence of an association of CNS tumour incidence with modelled exposure to background ionising radiation (RR per SD difference 1.17; 0.98-1.40) and with SEP (1.6; 1.00-1.13). CONCLUSION Of the investigated diagnostic groups, childhood CNS tumours showed the largest spatial variation. The selected covariates only partially explained the observed variation of CNS tumours suggesting that other environmental factors also play a role.
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Affiliation(s)
- Garyfallos Konstantinoudis
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
- Epidemiology and Biostatistics Department, School of Public Health, Imperial College London, London, UK.
| | - Dominic Schuhmacher
- Institute for Mathematical Stochastics, University of Göttingen, Göttingen, Germany
| | - Roland A Ammann
- Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tamara Diesch
- Division of Paediatric Oncology/Haematology, University Children's Hospital Basel, Basel, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Karalexi MA, Dessypris N, Georgakis MK, Ryzhov A, Jakab Z, Zborovskaya A, Dimitrova N, Zivkovic S, Trojanowski M, Sekerija M, Antunes L, Zagar T, Eser S, Bastos J, Demetriou A, Agius D, Coza D, Gheorghiu R, Kantzanou M, Ntzani EE, Petridou ET. Birth seasonality of childhood central nervous system tumors: Analysis of primary data from 16 Southern-Eastern European population-based registries. Int J Cancer 2020; 147:1252-1263. [PMID: 31957026 DOI: 10.1002/ijc.32875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022]
Abstract
Season of birth, a surrogate of seasonal variation of environmental exposures, has been associated with increased risk of several cancers. In the context of a Southern-Eastern Europe (SEE) consortium, we explored the potential association of birth seasonality with childhood (0-14 years) central nervous system (CNS) tumors. Primary CNS tumor cases (n = 6,014) were retrieved from 16 population-based SEE registries (1983-2015). Poisson regression and meta-analyses on birth season were performed in nine countries with available live birth data (n = 4,987). Subanalyses by birth month, age, gender and principal histology were also conducted. Children born during winter were at a slightly increased risk of developing a CNS tumor overall [incidence rate ratio (IRR): 1.06, 95% confidence intervals (CI): 0.99-1.14], and of embryonal histology specifically (IRR: 1.13, 95% CI: 1.01-1.27). The winter peak of embryonal tumors was higher among boys (IRR: 1.24, 95% CI: 1.05-1.46), especially during the first 4 years of life (IRR: 1.33, 95% CI: 1.03-1.71). In contrast, boys <5 years born during summer seemed to be at a lower risk of embryonal tumors (IRR: 0.73, 95% CI: 0.54-0.99). A clustering of astrocytomas was also found among girls (0-14 years) born during spring (IRR: 1.23, 95% CI: 1.03-1.46). Although the present exploratory results are by no means definitive, they provide some indications for age-, gender- and histology-related seasonal variations of CNS tumors. Expansion of registration and linkage with cytogenetic reports could refine if birth seasonality is causally associated with CNS tumors and shed light into the complex pathophysiology of this lethal disease.
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Affiliation(s)
- Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Cancer Institute & Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Zsuzsanna Jakab
- OGYR, Hun Childhood Cancer Registry, Semmelweis University, Budapest, Hungary
| | - Anna Zborovskaya
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Childhood Cancer Sub-registry of Belarus, Minsk, Belarus
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria
| | - Snezana Zivkovic
- Central Serbia Cancer Registry, Institute of Public Health of Serbia, Belgrade, Serbia
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Center, Poznan, Poland
| | - Mario Sekerija
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.,Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Tina Zagar
- Cancer Registry of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Ankara, Turkey
| | - Joana Bastos
- Registo Oncológico Regional do Centro (ROR-Centro), Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, Portugal
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | - Domenic Agius
- Department for Policy in Health Information and Research, Malta National Cancer Registry, Pieta, Malta
| | - Daniela Coza
- Cluj Regional Cancer Registry, The Oncology Institute "Prof. Dr. Ion Chiricuţă", Cluj-Napoca, Romania
| | - Raluca Gheorghiu
- Regional Cancer Registry, National Institute of Public Health, Iasi, Romania
| | | | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.,Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
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12
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Muskens IS, Feng Q, Francis SS, Walsh KM, Mckean-Cowdin R, Gauderman WJ, de Smith AJ, Wiemels JL. Pediatric glioma and medulloblastoma risk and population demographics: a Poisson regression analysis. Neurooncol Adv 2020; 2:vdaa089. [PMID: 32864610 PMCID: PMC7447139 DOI: 10.1093/noajnl/vdaa089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The incidence of pediatric brain tumors varies by race and ethnicity, but these relationships may be confounded by socioeconomic status (SES). In this study, the Surveillance, Epidemiology, and End Results Program (SEER) database was evaluated for associations between race/ethnicity and pediatric glioma and medulloblastoma risk with adjustment for SES. Methods Pediatric glioma and medulloblastoma cases from the SEER database (years: 2000–2016) were included. Differences in incidence rates by ethnicity, sex, age, and SES-related factors were evaluated by calculation of age-adjusted incidence rates (AAIRs) and annual percent change (APC). SES-related factors (percentage without less than high school graduation, median household income, and percentage foreign-born) were derived from the census at the county-level (year: 2000). Multivariable Poisson regression models with adjustment for selected covariates were constructed to evaluate risk factors. Results The highest AAIRs of pediatric glioma were observed among non-Hispanic Whites (AAIR: 2.91 per 100 000, 95%-CI: 2.84–2.99). An increasing incidence of pediatric glioma by calendar time was observed among non-Hispanic Whites and non-Hispanic Blacks (APC: 0.97%, 95%-CI: 0.28–1.68 and APC: 1.59%, 95%-CI: 0.03–3.18, respectively). Hispanic and non-Hispanic Black race/ethnicity was associated with lower risk when compared with non-Hispanic White (incidence rate ratios [IRRs]: 0.66, 95%-CI: 0.63–0.70; and 0.69, 95%-CI: 0.65–0.74, respectively). For medulloblastoma, the highest AAIR was observed for non-Hispanic Whites with a positive APC (1.52%, 95%-CI: 0.15–2.91). Hispanics and non-Hispanic Blacks had statistically significant lower IRRs compared with non-Hispanic Whites (IRRs: 0.83, 95%-CI: 0.73–0.94; and 0.72, 95%-CI: 0.59–0.87, respectively). Conclusion Non-Hispanic White race/ethnicity was associated with higher pediatric glioma and medulloblastoma IRRs in models with adjustments for SES.
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Affiliation(s)
- Ivo S Muskens
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Qianxi Feng
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephen S Francis
- Department of Neurosurgery, Division of Neuro and Molecular Epidemiology, University of California, San Francisco, California, USA
| | - Kyle M Walsh
- Department of Neurosurgery, Duke Cancer Institute, and Children's Health and Discovery Institute, Duke University, Durham, North Carolina, USA
| | - Roberta Mckean-Cowdin
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William J Gauderman
- Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Adam J de Smith
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joseph L Wiemels
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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13
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García-Pérez J, Gómez-Barroso D, Tamayo-Uria I, Ramis R. Methodological approaches to the study of cancer risk in the vicinity of pollution sources: the experience of a population-based case-control study of childhood cancer. Int J Health Geogr 2019; 18:12. [PMID: 31138300 PMCID: PMC6537179 DOI: 10.1186/s12942-019-0176-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Environmental exposures are related to the risk of some types of cancer, and children are the most vulnerable group of people. This study seeks to present the methodological approaches used in the papers of our group about risk of childhood cancers in the vicinity of pollution sources (industrial and urban sites). A population-based case–control study of incident childhood cancers in Spain and their relationship with residential proximity to industrial and urban areas was designed. Two methodological approaches using mixed multiple unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) were developed: (a) “near vs. far” analysis, where possible excess risks of cancers in children living near (“near”) versus those living far (“far”) from industrial and urban areas were assessed; and (b) “risk gradient” analysis, where the risk gradient in the vicinity of industries was assessed. For each one of the two approaches, three strategies of analysis were implemented: “joint”, “stratified”, and “individualized” analysis. Incident cases were obtained from the Spanish Registry of Childhood Cancer (between 1996 and 2011). Results Applying this methodology, associations between proximity (≤ 2 km) to specific industrial and urban zones and risk (OR; 95% CI) of leukemias (1.31; 1.04–1.65 for industrial areas, and 1.28; 1.00–1.53 for urban areas), neuroblastoma (2.12; 1.18–3.83 for both industrial and urban areas), and renal (2.02; 1.16–3.52 for industrial areas) and bone (4.02; 1.73–9.34 for urban areas) tumors have been suggested. Conclusions The two methodological approaches were used as a very useful and flexible tool to analyze the excess risk of childhood cancers in the vicinity of industrial and urban areas, which can be extrapolated and generalized to other cancers and chronic diseases, and adapted to other types of pollution sources.
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Affiliation(s)
- Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
| | - Diana Gómez-Barroso
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.,National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Ibon Tamayo-Uria
- Division of Immunology and Immunotherapy, Cima Universidad de Navarra and "Instituto de Investigación Sanitaria de Navarra (IdISNA)", Pamplona, Spain
| | - Rebeca Ramis
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
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14
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Yang Q, Wu J, Zhao J, Xu T, Zhao Z, Song X, Han P. Circular RNA expression profiles during the differentiation of mouse neural stem cells. BMC SYSTEMS BIOLOGY 2018; 12:128. [PMID: 30577840 PMCID: PMC6302452 DOI: 10.1186/s12918-018-0651-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Circular RNAs (circRNAs) have recently been found to be expressed in human brain tissue, and many lines ofevidence indicate that circRNAs play regulatory roles in neurodevelopment. Proliferation and differentiation of neural stem cells (NSCs) are critical parts during development of central nervous system (CNS).To date, there have been no reports ofcircRNA expression profiles during the differentiation of mouse NSCs. We hypothesizethat circRNAs mayregulate gene expression in the proliferation anddifferentiation of NSCs. Results In this study, we obtained NSCs from the wild-type C57BL/6 J mouse fetal cerebral cortex. We extracted total RNA from NSCs in different differentiation stagesand then performed RNA-seq. By analyzing the RNA-Seq data, we found 37circRNAs and 4182 mRNAs differentially expressedduringthe NSC differentiation. Gene Ontology (GO) enrichment analysis of thecognate linear genes of these circRNAsrevealed that some enriched GO terms were related to neural activity. Furthermore, we performed a co-expression network analysis of these differentially expressed circRNAs and mRNAs. The result suggested a stronger GO enrichmentin neural features for both the cognate linear genes of circRNAs and differentially expressed mRNAs. Conclusion We performed the first circRNA investigation during the differentiation of mouse NSCs. Wefound that12 circRNAs might have regulatory roles duringthe NSC differentiation, indicating that circRNAs might be modulated during NSC differentiation.Our network analysis suggested the possible complex circRNA-mRNA mechanisms during differentiation, and future experimental workis need to validate these possible mechanisms. Electronic supplementary material The online version of this article (10.1186/s12918-018-0651-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qichang Yang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China
| | - Jing Wu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China
| | - Jian Zhao
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China
| | - Tianyi Xu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.
| | - Xiaofeng Song
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China.
| | - Ping Han
- The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210019, Jiangsu, China.
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15
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Tamayo-Uria I, Boldo E, García-Pérez J, Gómez-Barroso D, Romaguera EP, Cirach M, Ramis R. Childhood leukaemia risk and residential proximity to busy roads. ENVIRONMENT INTERNATIONAL 2018; 121:332-339. [PMID: 30241021 DOI: 10.1016/j.envint.2018.08.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Current evidence suggests that childhood leukaemia can be associated with residential traffic exposure; nevertheless, more results are needed to support this conclusion. OBJECTIVES To ascertain the possible effects of residential proximity to road traffic on childhood leukaemia, taking into account traffic density, road proximity and the type of leukaemia (acute lymphoid leukaemia or acute myeloid leukaemia). METHODS We conducted a population-based case-control study of childhood leukaemia in Spain, covering the period 1990-2011. It included 1061 incidence cases gathered from the Spanish National Childhood Cancer Registry and those Autonomous Regions with 100% coverage, and 6447 controls, individually matched by year of birth, sex and autonomous region of residence. Distances were computed from the respective participant's residential locations to the different types of roads and four different buffers. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs), were calculated for four different categories of distance to roads. RESULTS Cases of childhood leukaemia had more than three-fold increased odds of living at <50 m of the busiest motorways compared to controls (OR = 2.90; 95%CI = 1.30-6.49). The estimates for acute lymphoid leukaemia (ALL) were slightly higher (OR = 2.95; 95%CI = 1.22-7.14), while estimates for cases with the same address at birth and at diagnosis were lower (OR = 2.40; 95%CI = 0.70-8.30). CONCLUSIONS Our study agrees with the literature and furnishes some evidence that living near a busy motorway could be a risk factor for childhood leukaemia.
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Affiliation(s)
- Ibon Tamayo-Uria
- Department of Statistics, Faculty of Arts and Sciences, Harvard University, Cambridge, 02138, MA, USA
| | - Elena Boldo
- Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain; Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Spain
| | - Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain; Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Spain
| | - Diana Gómez-Barroso
- Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Spain
| | - Elena Pardo Romaguera
- Spanish Registry of Childhood Tumours (RETI-SEHOP), University of Valencia, Valencia, Spain
| | - Marta Cirach
- ISGlobal, Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Rebeca Ramis
- Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain; Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Spain.
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16
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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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