Spatial distribution of incident pediatric Burkitt lymphoma in central and northern Malawi and association with malaria prevalence
Spatial distribution of incident pediatric Burkitt lymphoma in central and northern Malawi and association with malaria prevalence
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DOI：
10.1002/pbc.29867
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发表时间：
2022-08-03
影响因子：
3.2
通讯作者：
Westmoreland, Katherine D.
中科院分区：
文献类型：
--
作者：
Gondwe, Yolanda;Salima, Ande;Westmoreland, Katherine D.
伯基特淋巴瘤（BL）占撒哈拉以南非洲儿童淋巴瘤的90%。恶性疟原虫疟疾被认为是BL的病因。我们描述了马拉维儿童BL的地理分布及其与恶性疟原虫疟疾流行率（PfPR）的关系。方法我们将220例经病理证实的儿童BL病例（2013-2018年）纳入利隆圭区Kamuzu中心医院（KCH）的观察性临床队列。KCH是为马拉维中部和北方地区服务的主要三级癌症转诊中心。使用生态研究设计，我们计算了地区一级的年度BL发病率使用人口普查人口估计。地区一级的PfPR摘自2010年国家疟疾控制计划报告。在QGIS中构建BL发病率和PfPR图。Moran's I检验用于识别BL空间簇。Pearson相关分析和多元线性回归分析用于统计检查PfPR和BL之间的关系。结果中部地区BL发病率（8.2/100万）高于北方地区（2.9/100万），湖滨地区BL发病率更高。PfPR升高的地区BL发病率往往升高。在北部发现了一个低风险的BL集群。统计学上，BL发生率与PfPR呈正相关（r = 0.77，p <0.01）。当控制从转诊地区医院到KCH的旅行时间时，PfPR增加1%预测BL发病率增加0.2例/百万（p = 0.03）。结论我们的研究支持恶性疟原虫和BL之间的关联的证据，并强调需要提高地理可及性三级癌症服务在马拉维的北方地区。
Background Burkitt lymphoma (BL) accounts for 90% of pediatric lymphomas in sub-Saharan Africa. Plasmodium falciparum malaria is considered an etiological factor of BL. We describe the geographic distribution of pediatric BL in Malawi and association with P. falciparum malaria prevalence rate (PfPR). Methods We enrolled 220 pathologically confirmed incident pediatric BL cases (2013-2018) into an observational clinical cohort at Kamuzu Central Hospital (KCH) in Lilongwe district. KCH is the main tertiary cancer referral center serving the central and northern regions of Malawi. Using an ecological study design, we calculated district-level annual BL incidence rate using census population estimates. District-level PfPR was extracted from the National Malaria Control Program 2010 report. BL incidence and PfPR maps were constructed in QGIS. Moran's I test was used to identify BL spatial clusters. Pearson's correlation and multiple linear regression analyses were used to statistically examine the relationship between PfPR and BL. Results BL incidence was higher in central region districts (8.2 cases per million) than northern districts (2.9 cases per million) and was elevated in lakeshore districts. Districts with elevated PfPR tended to have elevated BL incidence. A low-risk BL cluster was detected in the north. Statistically, BL incidence was positively correlated with PfPR (r = .77, p < .01). A 1% increase in PfPR predicted an increase in BL incidence of 0.2 cases per million (p = .03), when controlling for travel time from referral district hospital to KCH. Conclusion Our study supports evidence for an association between P. falciparum and BL and highlights a need to improve geographic accessibility to tertiary cancer services in Malawi's northern region.