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Population mixing, socioeconomic status and incidence of childhood acute lymphoblastic leukaemia in England and Wales: analysis by census ward

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      Abstract

      In this population-based study of acute lymphoblastic leukaemia (ALL) diagnosed among children aged under 15 years in England and Wales during 1986–1995, we analysed incidence at census ward level in relation to a range of variables from the 1991 census, which could be relevant to theories of infectious aetiology. ‘Population-mixing' measures, used as surrogates for quantity and diversity of infections entering the community, were calculated from census data on the origins and destinations of migrants in the year before the census. Incidence at ages 1–4 years tended independently to be higher in rural wards, to increase with the diversity of origin wards from which in-migrants had moved during the year before the census, and to be lower in the most deprived areas as categorised by the Carstairs index. This last association was much weaker when urban/rural status and in-migrants' diversity were allowed for. There was no evidence of association with population mixing or deprivation for ALL diagnosed at ages 0 or 5–14 years. The apparent specificity to the young childhood age group suggests that these associations are particularly marked for precursor B-cell ALL, with the disease more likely to occur when delayed exposure to infection leads to increased immunological stress, as predicted by Greaves. The association with diversity of incomers, especially in rural areas, is also consistent with the higher incidence of leukaemia predicted by Kinlen, where population mixing results in below average herd immunity to an infectious agent.

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      Most cited references 35

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      A Mathematical Theory of Communication

       C. Shannon (1948)
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        Evidence for an infective cause of childhood leukaemia: comparison of a Scottish new town with nuclear reprocessing sites in Britain.

         L Kinlen (1988)
        Increases of leukaemia in young people that cannot be explained in terms of radiation have been recorded near both of Britain's nuclear reprocessing plants at Dounreay and Sellafield. These were built in unusually isolated places where herd immunity to a postulated widespread virus infection (to which leukaemia is a rare response) would tend to be lower than average. The large influxes of people in the 1950s to those areas might have been conducive to epidemics. The hypothesis has been tested in Scotland in an area identified at the outset as the only other rural area that received a large influx at the same time, when it was much more cut off from the nearest conurbation than at present--the New Town of Glenrothes. A significant increase of leukaemia below age 25 was found (10 observed, expected 3.6), with a greater excess below age 5 (7 observed, expected 1.5).
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          Epidemiological evidence for an infective basis in childhood leukaemia.

           L Kinlen (1995)
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            Author and article information

            Affiliations
            [1 ]simpleChildhood Cancer Research Group, Department of Paediatrics, University of Oxford Oxford OX2 6HJUK, UK
            [2 ]simpleSchool of Geography and Geosciences, Irvine Building, University of St Andrews St Andrews KY16 9AL, UK
            Author notes
            [* ]Author for correspondence: charles.stiller@ 123456ccrg.ox.ac.uk
            Journal
            Br J Cancer
            British Journal of Cancer
            Nature Publishing Group
            0007-0920
            1532-1827
            05 February 2008
            04 March 2008
            11 March 2008
            : 98
            : 5
            : 1006-1011
            2266854
            6604237
            10.1038/sj.bjc.6604237
            18253115
            Copyright 2008, Cancer Research UK
            Categories
            Epidemiology

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