RE: "RACIAL AND ETHNIC DIFFERENCES IN SOCIOECONOMIC POSITION AND RISK OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA".
RE: "RACIAL AND ETHNIC DIFFERENCES IN SOCIOECONOMIC POSITION AND RISK OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA".
复制标题
回复：“社会经济地位和儿童急性淋巴细胞白血病风险的种族和民族差异”。
DOI：
10.1093/aje/kwz075
复制
发表时间：
2019
影响因子：
5
通讯作者：
Scheurer,MichaelE
中科院分区：
文献类型：
--
作者：
Spector,LoganG;DeWan,AndrewT;Pankratz,NathanD;Turcotte,LucieM;Yang,JunJ;Scheurer,MichaelE
我们饶有兴趣地阅读了 Wang 等人 (1) 的关于按社会经济地位 (SEP) 和种族/族裔划分的儿童急性淋巴细胞白血病 (ALL) 发病率的报告。他们报告了在白人、黑人、西班牙裔和亚洲儿童的监测、流行病学和最终结果人群中比较 SEP 4 个最高水平与最低水平的比率。虽然提供了丰富的信息，但作者未展示的这些数据的另一种呈现方式——比较 SEP 阶层内种族/族裔的发生率比率——也具有启发意义。我们使用 Wang 等人提供的数据，以白人儿童为参考组，计算了这些发生率比率（和 95% 置信区间）（表 1）。在所有 SEP 水平上，黑人儿童的发病率比白人儿童低大约一半。相比之下，在SEP最低层中，西班牙裔的发病率比非西班牙裔白人儿童的发病率要高得多，但随着SEP的上升，该比率下降，直到最高层为零。在亚洲儿童中，与白人儿童相比，ALL 的发病率没有显着性差异，但低 SEP 阶层的发病率比略低。虽然由于缺乏个人信息，对监测数据的解释必然是推测性的，但我们可能会得出一些初步的结论。与白人儿童相比，在所有 SEP 水平上，黑人儿童 ALL 的发病率均较低，这表明大量的非洲血统压倒了环境风险。在西班牙裔儿童中，随着 SEP 的增加，发病率比率下降的明显梯度可能代表特定种族的差异，但也可能反映出欧洲混血的增加 (2)。亚洲儿童中 SEP 的两个最低层中 ALL 的发病率呈较低趋势；我们注意到，在美国，东南亚族群的 SEP 低于东亚族群 (3)。总的来说，这些结果表明了血统在 ALL 风险中的重要性。结果进一步表明，在广泛存在欧洲/非欧洲混血的人群中，包括黑人和西班牙裔儿童，混血作图可以识别导致风险差异的特定位点和变异 (4)。
We read with interest the report by Wang et al.(1) on the incidence of childhood acute lymphoblastic leukemia (ALL) by socioeconomic position (SEP) and race/ethnicity. They reported rate ratios comparing the 4 highest levels of SEP with the lowest within Surveillance, Epidemiology, and End Results populations of white, black, Hispanic, and Asian children. While informative, an alternative presentation of these data that was not shown by the authors—incidence rate ratios comparing races/ethnicities within strata of SEP—is also revealing. We calculated these incidence rate ratios (and 95% confidence intervals), with white children as the reference group, using the data provided by Wang et al.(Table 1). At all levels of SEP, the incidence rate ratio was substantially and significantly lower by roughly half among black compared with white children. In contrast, the incidence rate ratio was substantially higher among Hispanic than among non-Hispanic white children in the lowest stratum of SEP, but it fell with rising SEP until becoming null at the highest stratum. Among Asian children there was no significant incidence rate ratio for ALL compared with white children, except for a slightly lower incidence rate ratio in the low-SEP stratum. While interpretation of surveillance data is necessarily speculative due to the lack of information on individuals, we might draw some tentative conclusions. That the incidence rate ratio for ALL among black compared with white children was lower at all levels of SEP suggests environmental risk is outweighed by substantial African ancestry. Among Hispanic children, the clear gradient of decreasing incidence rate ratio with increasing SEP could represent differences in specific ethnicity but might also reflect increasing European admixture (2). There was a trend towards lower incidence rate ratios for ALL in the 2 lowest strata of SEP among Asian children; we note that Southeast Asian ethnic groups have lower SEP than East Asians in the United States (3). Collectively these results point to the importance of ancestry in risk of ALL. The results further suggest that among populations with widespread European/non-European admixture, including black and Hispanic children, admixture mapping could identify specific loci and variants conferring differences in risk (4).