Social class and age at diagnosis of Hodgkin's disease: new epidemiologic evidence for the "two-disease hypothesis".
Social class and age at diagnosis of Hodgkin's disease: new epidemiologic evidence for the "two-disease hypothesis".
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霍奇金病诊断时的社会阶层和年龄：“两种疾病假说”的新流行病学证据。
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发表时间：
1982
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通讯作者：
N. Gutensohn
中科院分区：
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作者：
N. Gutensohn
何杰金氏病（HD）的年龄发病模式的双峰性表明，该疾病可能是由两个不同年龄高峰的致病途径引起的。在年轻人中，HD可能是常见感染（可能是病毒）的罕见后果，感染时风险随着年龄的增长而增加。然而，在老年人中，HD可能由其他原因引起，可能与其他淋巴瘤相似。我们在马萨诸塞州东部进行了一项以人群为基础的病例对照研究，其中包括326例新诊断病例（患者年龄大于或等于15岁）和650例人群对照。这些受试者比较了儿童环境中影响暴露于常见病毒的年龄的因素，包括兄弟姐妹的大小，父母的教育和住房类型。在年轻人（15-39岁）中，HD的风险与小家庭规模、单户住房和相对较高的母亲教育程度相关，与延迟感染暴露假设一致。在中年人（40-54岁）中，存在类似的社会阶层风险因素模式。然而，在老年人（大于或等于55岁）中，风险与社会阶层无关;如果有的话，患者的社会阶层背景略低于对照组。这些发现与“两种疾病假说”一致，即社会阶层风险因素在年轻人和老年人之间存在差异。这些发现，加上其他流行病学观察，表明HD的发病机制在老年人是独立的年轻人。
The bimodality in the age-incidence pattern of Hodgkin's disease (HD) suggests that the disease may result from two causal pathways with differing age peaks. Among young adults, HD may develop as a rare consequence of a common infection (probably viral), with risk increasing with age at time of infection. However, among older persons, HD may result from other causes, probably similar to those of the other lymphomas. We evaluated this hypothesis in a population-based, case-control study in eastern Massachusetts involving 326 newly diagnosed cases (patients greater than or equal to 15 years of age) and 650 population controls. These subjects were compared for factors in childhood environment that influence age of exposure to common viruses, including sibship size, parental education, and type of housing. Among young adults (15-39 years of age), risk of HD was associated with small family size, single-family housing, and relatively high maternal education, consistent with the delayed infectious exposure hypothesis. Among middle-aged persons (40-54 years of age), a similar pattern of social class risk factors was present. However, among older persons (greater than or equal to 55 years of age), risk was not associated with social class; if anything, patients were of somewhat lower social class background than controls. These findings are consistent with the "two-disease hypothesis," in that social class risk factors differed between younger and older persons. These findings, coupled with other epidemiologic observations, suggest that the pathogenesis of HD among older persons is independent of that among younger persons.