Childhood Leukemia and Socioeconomic Status in Canada

Borugian, Marilyn J.; Spinelli, John J.; Mezei, Gábor; Wilkins, Russell; Abanto, Zenaida; McBride, Mary L.

doi:10.1097/01.ede.0000164813.46859.63

Cited by 96 publications

(81 citation statements)

References 20 publications

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“…The proportion of county families living below the poverty level was inversely associated with incidence of ALL among females. Studies of SES and childhood ALL have been inconsistent, with elevated rates in higher-SES areas found by some (Pinkel and Nefzger, 1959;Fasal et al, 1971;Sanders et al, 1981;McWhirter, 1982;Laval et al, 1988;Cook-Mozaffari et al, 1989;Alexander et al, 1990a;Kinlen et al, 1995;Stiller and Boyle, 1996;Dockerty et al, 2001;Borugian et al, 2005), but not others (Alexander et al, 1990b;Kinlen et al, 1993;Dickinson and Parker, 1999). Our findings for household income and proportion of households below the poverty level better fit the former group, though from the shape of the curves, it appears that the issue is abject poverty rather the continuum of SES per se.…”

Section: Discussioncontrasting

confidence: 46%

“…Some studies reported elevated childhood leukaemia rates in higher-SES areas (Kinlen et al, 1995;Stiller and Boyle, 1996;Borugian et al, 2005), whereas other studies have found no association (Alexander et al, 1990b;Kinlen et al, 1993;Dickinson and Parker, 1999). This study aimed (1) to expand our understanding of the possible infectious nature of childhood ALL by examining its association with residential relocation, population change, and urbanisation, (2) to examine its relation with housing age (newlyconstructed housing may reflect population growth or influx, but has not been previously studied), and (3) to clarify its relationship with SES by examining household income and the proportion of families below the poverty level.…”

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confidence: 99%

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Residential mobility and risk of childhood acute lymphoblastic leukaemia: an ecological study

et al. 2007

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We conducted an ecological analysis of childhood acute lymphoblastic leukaemia-incidence data from children p5 years old during 1992 -1998 from the Surveillance, Epidemiology, and End Results Program in 200 counties and Hawaii. The response variable was the count of cases in each county race -sex stratum, examined in relation to data from the United States Census and the United States Department of Agriculture. The final models for both sexes included race, proportion moved during 1985 -1990, and proportion of households with income X$5000 as potential predictors. Incidence was lower among black boys (rate ratio (RR) ¼ 0.5) and black girls (RR ¼ 0.4) than among other children of the same sex; no other significant racial differences were detected. Incidence was elevated among males (but not females) residing in counties where X50% of the population relocated (RR ¼ 1.5) and among females (but not males) residing in counties where o6% of the households had incomes o$5000 (RR ¼ 1.5). These sex differences in risk factors were unexpected.

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Section: Discussioncontrasting

confidence: 46%

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confidence: 99%

Residential mobility and risk of childhood acute lymphoblastic leukaemia: an ecological study

et al. 2007

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“…Two suggested a relative protection of children living in the most deprived area (34,38) , one suggested an increased risk in this group (for residence at birth only (39) ) and one showed no effect (37) . However, overall, the effect sizes were small and only evident in the most extreme quantiles (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Childhood leukaemia and socioeconomic status: what is the evidence?

Adam

Rebholz

Egger

et al. 2008

Radiation Protection Dosimetry

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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. (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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“…Numerous studies have shown an elevated risk of childhood leukaemia or ALL in areas of higher socioeconomic status (Githens et al, 1965;Alexander et al, 1990a;Draper et al, 1991;Stiller and Boyle, 1996;Borugian et al, 2005). In our 1979 -1985 study, it was suggested that the socioeconomic gradient might be largely due to population mixing (Stiller and Boyle, 1996), but the present study showed a substantial effect of socioeconomic status after urbanisation and incomers' diversity had been allowed for (see above).…”

Section: Discussionmentioning

confidence: 99%

Population mixing, socioeconomic status and incidence of childhood acute lymphoblastic leukaemia in England and Wales: analysis by census ward

et al. 2008

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In this population-based study of acute lymphoblastic leukaemia (ALL) diagnosed among children aged under 15 years in England and Wales during 1986 -1995, we analysed incidence at census ward level in relation to a range of variables from the 1991 census, which could be relevant to theories of infectious aetiology. 'Population-mixing' measures, used as surrogates for quantity and diversity of infections entering the community, were calculated from census data on the origins and destinations of migrants in the year before the census. Incidence at ages 1 -4 years tended independently to be higher in rural wards, to increase with the diversity of origin wards from which in-migrants had moved during the year before the census, and to be lower in the most deprived areas as categorised by the Carstairs index. This last association was much weaker when urban/rural status and in-migrants' diversity were allowed for. There was no evidence of association with population mixing or deprivation for ALL diagnosed at ages 0 or 5 -14 years. The apparent specificity to the young childhood age group suggests that these associations are particularly marked for precursor B-cell ALL, with the disease more likely to occur when delayed exposure to infection leads to increased immunological stress, as predicted by Greaves. The association with diversity of incomers, especially in rural areas, is also consistent with the higher incidence of leukaemia predicted by Kinlen, where population mixing results in below average herd immunity to an infectious agent.

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Childhood Leukemia and Socioeconomic Status in Canada

Abstract: This analysis suggests that high SES is a true risk factor for childhood leukemia and that inconsistent results from other studies may be related to differences in case ascertainment or study participation.

Cited by 96 publications

References 20 publications

Residential mobility and risk of childhood acute lymphoblastic leukaemia: an ecological study

Residential mobility and risk of childhood acute lymphoblastic leukaemia: an ecological study

Childhood leukaemia and socioeconomic status: what is the evidence?

Population mixing, socioeconomic status and incidence of childhood acute lymphoblastic leukaemia in England and Wales: analysis by census ward

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