Population density and childhood leukaemia: Results of the EUROCLUS study
Population density and childhood leukaemia: Results of the EUROCLUS study
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DOI：
10.1016/s0959-8049(98)00385-2
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发表时间：
1999-03-01
影响因子：
8.4
通讯作者：
Wray, N
中科院分区：
文献类型：
--
作者：
Alexander, FE;Boyle, P;Wray, N
EUROCLUS研究收集了17个国家（或国家地区）1980年至1989年期间诊断的13551例儿童白血病（CL）病例的发病率数据。这些被引用的位置在诊断小的人口普查区，其中有25 723在研究区域。所有这些小地区都有人口数、面积和人口密度。以前的分析表明，在小区域内病例数的额外泊松变异（EPV）有限;这在中等人口密度（150-499人/km（2））的地区最为明显。在本研究中，对数据集进行了更详细的检查，以获得CL发生率和EPV变化与人群密度相关的证据。发病率与人口密度呈曲线关系，在人口密度较高的地区发病率最高（500-750人/km（2）），其中，相对于大于或等于1000人/km（2）的地区的发病率比率为1.16（95%置信区间1.07-1.26），8个种群密度层间二次趋势的P值为0.02。这些地区的发病率一致升高，没有显示异质性（即EPV）的证据。在一些以前被归类为中等密度地区的地区（特别是那些密度为250-499人/km（2）的地区，CL的P < 0.001）中，EPV的统计学显著证据是明显的。这些结果被解释为目前的病因学假设CL提出，暴露于局部流行的一种或多种常见的传染性病原体可能有助于白血病的发展。他们认为，这种流行病经常出现在人口密度中等的地区，也偶尔出现在人口密度稍低的地区。虽然其他的解释是可能的，这些结果可能有助于：在识别的特性，传染性病原体必须具备的，如果直接或间接的原因CL。(C)1999 Elsevier Science Ltd.保留所有权利。
The EUROCLUS study assembled incidence data for 13 551 cases of childhood leukaemia (CL) diagnosed between 1980 and 1989 in 17 countries (or regions of countries). These were referenced by location at diagnosis to small census areas of which there were 25 723 in the study area. Population counts, surface area and, hence, population density were available for all these small areas. Previous analyses have shown limited extra-Poisson variation (EPV) of case counts within small areas; this is most pronounced in areas of intermediate population density (150-499 persons/km(2)). In this study, the data set was examined in more detail for evidence that variations in incidence and EPV of CL are associated with population density. Incidence showed a curvilinear association with population density and was highest in areas which were somewhat more densely populated (500-750 persons/km(2)), where the incidence rate ratio relative to areas having greater than or equal to 1000 persons/km(2) was 1.16 (95% confidence interval 1.07-1.26) and the P value for quadratic trend across eight strata of population density was 0.02. Incidence in these areas is uniformly elevated and showed no evidence of heterogeneity (i.e. EPV). Statistically significant evidence of EPV was evident amongst some of the areas previously classified as intermediate density areas (specifically, those with a density of 250-499 persons/km(2), P < 0.001 for CL). These results were interpreted in terms of the current aetiological hypotheses for CL which propose that exposure to localised epidemics of one or more common infectious agent may contribute to the development of leukaemia. They suggest that such epidemics arise regularly in moderately densely populated areas and also sporadically in areas which are somewhat less densely populated. Although other interpretations are possible, these results may assist: in the identification of characteristics which infectious agents must possess if direct or indirect causes of CL. (C) 1999 Elsevier Science Ltd. All rights reserved.