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Spatial clustering of childhood leukaemia with the integration of the Paediatric Environmental History

机译：儿童白血病与儿童环境史的整合

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摘要

Abstract Background Leukaemia remains the most common type of paediatric cancer and its aetiology remains unknown, but considered to be multifactorial. It is suggested that the initiation in utero by relevant exposures and/or inherited genetic variants and, other promotional postnatal exposures are probably required to develop leukaemia. This study aimed to map the incidence and analyse possible clusters in the geographical distribution of childhood acute leukaemia during the critical periods and to evaluate the factors that may be involved in the aetiology by conducting community and individual risk assessments. Materials and methods We analysed all incident cases of acute childhood leukaemia (15 years) diagnosed in a Spanish region during the period 1998–2013. At diagnosis, the addresses during pregnancy, early childhood and diagnosis were collected and codified to analyse the spatial distribution of acute leukaemia. Scan statistical test methodology was used for the identification of high-incidence spatial clusters. Once identified, individual and community risk assessments were conducted using the Paediatric Environmental History. Results A total of 158 cases of acute leukaemia were analysed. The crude rate for the period was 42.7 cases per million children. Among subtypes, acute lymphoblastic leukaemia had the highest incidence (31.9 per million children). A spatial cluster of acute lymphoblastic leukaemia was detected using the pregnancy address (p0.05). The most common environmental risk factors related with the aetiology of acute lymphoblastic leukaemia, identified by the Paediatric Environmental History were: prenatal exposure to tobacco (75%) and alcohol (50%); residential and community exposure to pesticides (62.5%); prenatal or neonatal ionizing radiation (42.8%); and parental workplace exposure (37.5%) Conclusions Our study suggests that environmental exposures in utero may be important in the development of childhood leukaemia. Due to the presence of high-incidence clusters using pregnancy address, it is necessary to introduce this address into the childhood cancer registers. The Paediatric Environmental History which includes pregnancy address and a careful and comprehensive evaluation of the environmental exposures will allow us to build the knowledge of the causes of childhood leukaemia. Highlights • A spatial cluster of ALL was detected using the pregnancy address. • The spatial cluster is not significant when we use diagnostic address. • Environmental exposures in utero could help to develop a childhood leukaemia. • The Paediatric Environmental History helps to identify environmental risk factors. • Pregnancy address should be included into childhood cancer registries.
机译： 摘要 背景 白血病仍然是儿童癌症的最常见类型其病因仍然未知，但被认为是多因素的。建议通过相关暴露和/或遗传遗传变异在子宫内开始 ，可能还需要其他促进产后暴露以发展白血病。这项研究旨在绘制关键时期的发病率并分析儿童急性白血病地理分布中的可能聚类，并通过进行社区和个人风险评估来评估可能的病因学因素。 材料和方法 我们分析了1998-2013年在西班牙地区诊断出的所有急性儿童白血病（<15岁）事件。在诊断时，将怀孕，幼儿期和诊断期间的地址收集起来并进行整理，以分析急性白血病的空间分布。扫描统计测试方法用于识别高发空间群。一旦确定，将使用“儿科环境历史记录”进行个人和社区风险评估。 结果 总共158例急性白血病被分析。这段时期的粗略率为每百万儿童42.7例。在亚型中，急性淋巴细胞白血病的发病率最高（每百万儿童中有31.9例）。使用妊娠地址检测到急性淋巴细胞性白血病的空间簇（p <0.05）。根据儿科环境史，与急性淋巴细胞白血病的病因相关的最常见的环境危险因素是：产前暴露于烟草（75％）和酒精（50％）；居民和社区接触农药的情况（62.5％）；产前或新生儿电离辐射（42.8％）；和父母的工作场所暴露（37.5％） 结论 我们的研究表明，子宫内的环境暴露可能对儿童的成长很重要白血病。由于存在使用怀孕地址的高发人群，因此必须将此地址引入儿童癌症登记册。儿科环境史，包括妊娠报告和对环境暴露的仔细而全面的评估，将使我们能够了解儿童白血病的病因。 突出显示 •< / ce：label> 使用怀孕地址检测到ALL的空间簇。 • 当我们使用诊断地址时，空间聚类并不重要。 • 子宫内环境暴露可能有助于发展儿童白血病。 • 儿科环境史有助于识别环境风险因素。 • 怀孕地址应纳入儿童癌症登记处。

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  • 来源
    《Environmental research》 |2017年第7期|605-612|共8页
  • 作者

    Alberto Cárceles-Álvarez; Juan A. Ortega-García; Fernando A. López-Hernández; Mayra Orozco-Llamas; Blanca Espinosa-López; Esther Tobarra-Sánchez; Lizbeth Alvarez;

  • 作者单位

    Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia;

    Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia;

    Departamento de Métodos Cuantitativos e Informáticos, Universidad Politécnica de Cartagena;

    Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia;

    Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia;

    Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia;

    Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia;

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  • 正文语种 eng
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  • 关键词

    Spatial clustering; Childhood leukaemia; Environmental health; Prenatal exposure; Scan statistic;

    机译：空间聚集;儿童白血病;环境卫生;产前暴露;扫描统计;

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