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Population mixing and the risk of childhood leukaemia in Switzerland: a census-based cohort study

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Abstract

Childhood leukaemia (CL) may have an infectious cause and population mixing may therefore increase the risk of CL. We aimed to determine whether CL was associated with population mixing in Switzerland. We followed children aged <16 years in the Swiss National Cohort 1990–2008 and linked CL cases from the Swiss Childhood Cancer Registry to the cohort. We calculated adjusted hazard ratios (HRs) for all CL, CL at age <5 years and acute lymphoblastic leukaemia (ALL) for three measures of population mixing (population growth, in-migration and diversity of origin), stratified by degree of urbanisation. Measures of population mixing were calculated for all municipalities for the 5-year period preceding the 1990 and 2000 censuses. Analyses were based on 2,128,012 children of whom 536 developed CL. HRs comparing highest with lowest quintile of population growth were 1.11 [95 % confidence interval (CI) 0.65–1.89] in rural and 0.59 (95 % CI 0.43–0.81) in urban municipalities (interaction: p = 0.271). Results were similar for ALL and for CL at age <5 years. For level of in-migration there was evidence of a negative association with ALL. HRs comparing highest with lowest quintile were 0.60 (95 % CI 0.41–0.87) in urban and 0.61 (95 % CI 0.30–1.21) in rural settings. There was little evidence of an association with diversity of origin. This nationwide cohort study of the association between CL and population growth, in-migration and diversity of origin provides little support for the population mixing hypothesis.

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Acknowledgments

This study was supported by Swiss Cancer Research (# 3049-08-2012, # 3515-08-2014), the Swiss Federal Office of Public Health (# 08.001616, #10.002946, # 12.008357) and the Swiss Cancer League (#02224-03-2008). B.D. Spycher was supported by a Swiss National Science Foundation fellowship (PZ00P3_147987). The work of the Swiss Childhood Cancer Registry is supported by the Swiss Paediatric Oncology Group (www.spog.ch), Schweizerische Konferenz der kantonalen Gesundheitsdirektorinnen und—direktoren (www.gdk-cds.ch), Swiss Cancer Research (www.krebsforschung.ch), Kinderkrebshilfe Schweiz (www.kinderkrebshilfe.ch), Ernst-Göhner Stiftung, Stiftung Domarena and National Institute of Cancer Epidemiology and Registration (www.nicer.ch).

Conflict of interest

The authors declare that they have no conflict of interest

Ethical standard

Approval of the study was granted through the general cancer registry permission of the Swiss Childhood Cancer Registry by the ethics committee of the canton of Bern.

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Authors and Affiliations

  1. Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland

    Judith E. Lupatsch, Claudia E. Kuehni, Matthias Egger & Ben D. Spycher

  2. University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Felix Niggli

  3. Department of Paediatrics, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland

    Roland A. Ammann

  4. Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa

    Matthias Egger

Authors
  1. Judith E. Lupatsch
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  2. Claudia E. Kuehni
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  3. Felix Niggli
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  4. Roland A. Ammann
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  5. Matthias Egger
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Corresponding author

Correspondence to Ben D. Spycher.

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For the Swiss Paediatric Oncology Group and the Swiss National Cohort Study Group.

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Appendix

Appendix

The members of the Swiss Pediatric Oncology Group Scientific Committee

R. A. Ammann (Bern), R. Angst (Aarau), M. Ansari (Geneva), M. Beck Popovic(Lausanne), E. Bergstraesser (Zurich), P. Brazzola (Bellinzona), J. Greiner (St. Gallen), M. Grotzer (Zurich), H. Hengartner (St. Gallen), T. Kuehne (Basel), K. Leibundgut (Bern), F. Niggli (Zurich), J. Rischewski (Lucerne), N. von der Weid (Basel).

The members of the Swiss National Cohort Study Group

M. Egger (Bern), A. Spoerri (Bern), M. Zwahlen (Bern), M. Puhan (Zurich), M. Bopp (Zurich), D. Fäh (Zurich), N. Künzli (Basel), F. Paccaud (Lausanne), M. Oris (Geneva), M. Schwyn (Neuchâtel).

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Lupatsch, J.E., Kuehni, C.E., Niggli, F. et al. Population mixing and the risk of childhood leukaemia in Switzerland: a census-based cohort study. Eur J Epidemiol 30, 1287–1298 (2015). https://doi.org/10.1007/s10654-015-0042-5

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