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Temporal association between childhood leukaemia and population growth in Swiss municipalities

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Abstract

The population mixing hypothesis proposes that childhood leukaemia (CL) might be a rare complication of a yet unidentified subclinical infection. Large population influxes into previously isolated rural areas may foster localised epidemics of the postulated infection causing a subsequent increase of CL. While marked population growth after a period of stability was central to the formulation of the hypothesis and to the early studies on population mixing, there is a lack of objective criteria to define such growth patterns. We aimed to determine whether periods of marked population growth coincided with increases in the risk of CL in Swiss municipalities. We identified incident cases of CL aged 0–15 years for the period 1985–2010 from the Swiss Childhood Cancer Registry. Annual data on population counts in Swiss municipalities were obtained for 1980–2010. As exposures, we defined (1) cumulative population growth during a 5-year moving time window centred on each year (1985–2010) and (2) periods of ‘take-off growth’ identified by segmented linear regression. We compared CL incidence across exposure categories using Poisson regression and tested for effect modification by degree of urbanisation. Our study included 1500 incident cases and 2561 municipalities. The incident rate ratio (IRR) comparing the highest to the lowest quintile of 5-year population growth was 1.18 (95 % CI 0.96, 1.46) in all municipalities and 1.33 (95 % CI 0.93, 1.92) in rural municipalities (p value interaction 0.36). In municipalities with take-off growth, the IRR comparing the take-off period (>6 % annual population growth) with the initial period of low or negative growth (<2 %) was 2.07 (95 % CI 0.95, 4.51) overall and 2.99 (1.11, 8.05) in rural areas (p interaction 0.52). Our study provides further support for the population mixing hypothesis and underlines the need to distinguish take-off growth from other growth patterns in future research.

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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), the Federal Office of Health (FOH) and the National Institute of Cancer Epidemiology and Registration (www.nicer.ch). 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 (Chairman of the Executive Board), A. Spoerri (University of Bern), M. Zwahlen (University of Bern), M. Puhan (Chairman of the Scientific Board), M. Bopp (University of Zurich), D. Fäh (University of Zurich), N. Künzli (University of Basel), F. Paccaud (University of Lausanne), M. Oris (University of Geneva), M. Schwyn (Swiss Federal Statistical Office, Neuchâtel).

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Authors and Affiliations

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

    Judith E. Lupatsch, Christian Kreis, Marcel Zwahlen, Claudia E. Kuehni & Ben D. Spycher

  2. University Children’s Hospital Zurich, Zurich, Switzerland

    Felix Niggli

  3. Department of Paediatrics, University of Bern, Bern, Switzerland

    Roland A. Ammann

Authors
  1. Judith E. Lupatsch
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  2. Christian Kreis
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  3. Marcel Zwahlen
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  4. Felix Niggli
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  5. Roland A. Ammann
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  6. Claudia E. Kuehni
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  7. Ben D. Spycher
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Consortia

Swiss Paediatric Oncology Group

  • R. A. Ammann
  • , R. Angst
  • , M. Ansari
  • , M. Beck Popovic
  • , E. Bergstraesser
  • , P. Brazzola
  • , J. Greiner
  • , M. Grotzer
  • , H. Hengartner
  • , T. Kuehne
  • , K. Leibundgut
  • , F. Niggli
  • , J. Rischewski
  •  & N. von der Weid

Swiss National Cohort Study Group

  • M. Egger
  • , A. Spoerri
  • , M. Zwahlen
  • , M. Puhan
  • , M. Bopp
  • , D. Fäh
  • , N. Künzli
  • , F. Paccaud
  • , M. Oris
  •  & M. Schwyn

Corresponding author

Correspondence to Ben D. Spycher.

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Ethics approval was granted through the ethics committee of the canton of Bern to the SCCR.

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Lupatsch, J.E., Kreis, C., Zwahlen, M. et al. Temporal association between childhood leukaemia and population growth in Swiss municipalities. Eur J Epidemiol 31, 763–774 (2016). https://doi.org/10.1007/s10654-016-0162-6

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  • DOI: https://doi.org/10.1007/s10654-016-0162-6

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