An ecologic study of childhood leukemia and population mixing in Ontario, Canada

Cancer Causes & Control volume 12, pages483–490(2001)Cite this article

Abstract

Objective: To examine the association between population mixing and the incidence of childhood leukemia, specifically the acute lymphocytic leukemia (ALL) subtype among young children.

Methods: This ecologic study was based on incidence rates of leukemia in children aged 0–14 years. The Ontario Cancer Registry was used to identify the residence of 1394 leukemia cases between 1978 and 1992. Ecologic units were composed of census subdivisions in a 5-year period. Percent population change, determined from the Census of Canada, was employed as a measure of population mixing. The relationship between population mixing and childhood leukemia was examined separately after stratifying by the level of geographic isolation, defined according to urban–rural status. Analyses were also conducted separately in specific age groups and for the ALL subtype.

Results: Population growth in rural areas was associated with an increased incidence of leukemia, particularly for the ALL subtype in children aged 0–4 years (rate ratio = 1.8, 95% confidence interval 1.1–2.8, for a greater than 20% population change relative to no increase in population). In contrast, an elevated risk due to population mixing was not observed in urban areas.

Conclusions: Results from this study are consistent with results from similar studies conducted in the United Kingdom, which are suggestive of a role for an infectious agent in the etiology of childhood leukemia, as proposed in the Kinlen hypothesis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

US$ 39.95

Tax calculation will be finalised during checkout.

References

  1. 1.

    Alexander FE (1993) Viruses, clusters and clustering of childhood leukaemia: a new perspective? Eur J Cancer 29A: 1424–1443.

    Google Scholar 

  2. 2.

    Schulz TF, Neil JC (1996) Viruses and leukemia. In: Henderson ES, Lister TA, Greaves MF, eds. Leukemia, 6th edn. Philadelphia: Saunders, pp. 160–178.

    Google Scholar 

  3. 3.

    Kinlen LJ (1988) Evidence for an infective cause of childhood leukaemia: comparison of a Scottish New Town with nuclear reprocessing sites in Britain. Lancet 2: 1323–1327.

    Google Scholar 

  4. 4.

    Kinlen LJ (1995) Epidemiological evidence for an infective basis in childhood leukaemia. Br J Cancer 71: 1–5.

    Google Scholar 

  5. 5.

    Kinlen LJ, Dickson M, Stiller CA (1995) Childhood leukaemia and non-Hodgkin's lymphoma near large rural construction sites, with a comparison with Sellafield nuclear site. BMJ 310: 763–768.

    Google Scholar 

  6. 6.

    Kinlen LJ, Petridou E (1995) Childhood leukemia and rural population movements: Greece, Italy, and other countries. Cancer Causes Control 6: 445–450.

    Google Scholar 

  7. 7.

    Gilman EA, Knox EG (1998) Geographical distribution of birth places of children with cancer in the UK. Br J Cancer 77: 842–849.

    Google Scholar 

  8. 8.

    Langford I (1991) Childhood leukaemia mortality and population change in England and Wales 1969–73. Soc Sci Med 33: 435–440.

    Google Scholar 

  9. 9.

    Rodrigues L, Hills M, McGale P, Elliott P (1991) Socio-economic factors in relation to childhood leukaemia and non-Hodgkin lymphomas: an analysis based on small area statistics for census tracts. In: Draper GJ, ed. The Geographical Epidemiology of Childhood Leukaemia and Non-Hodgkin's Lymphomas in Great Britain, 1966–83, London: HMSO, pp. 47–56.

    Google Scholar 

  10. 10.

    Stiller CA, Boyle PJ (1996) Effect of population mixing and socioeconomic status in England and Wales, 1979–85, on lymphoblastic leukaemia in children. BMJ 313: 1297–1300.

    Google Scholar 

  11. 11.

    Alexander FE, Chan LC, Lam TH, et al. (1997) Clustering of childhood leukaemia in Hong Kong: association with the childhood peak and common acute lymphoblastic leukaemia and with population mixing. Br J Cancer 75: 457–463.

    Google Scholar 

  12. 12.

    Dickinson HO, Parker L (1999) Quantifying the effect of population mixing on childhood leukaemia risk: the Seascale cluster. Br J Cancer 81: 144–151.

    Google Scholar 

  13. 13.

    MacMahon B (1992) Is acute lymphoblastic leukemia in children virus-related? Am J Epidemiol 136: 916–924.

    Google Scholar 

  14. 14.

    Alexander FE, Ricketts TJ, McKinney PA, Cartwright RA (1990) Community lifestyle characteristics and risk of acute lymphoblastic leukaemia in children. Lancet 336: 1461–1465.

    Google Scholar 

  15. 15.

    Petridou E, Hsieh CC, Kotsifakis G, Skalkidis Y, Trichopoulos D (1991) Absence of leukaemia clustering on Greek islands. Lancet 338: 1204–1205.

    Google Scholar 

  16. 16.

    Dockerty JD, Cox B, Borman B, Sharples K (1996) Population mixing and the incidence of childhood leukaemias: retrospective comparison in rural areas of New Zealand. BMJ 312: 1203–1204.

    Google Scholar 

  17. 17.

    National Cancer Institute of Canada (2000) Canadian Cancer Statistics 2000. Toronto, Ontario: NCIC.

    Google Scholar 

  18. 18.

    Statistics Canada (1993) Geography Guide Book. Ottawa: Industry, Science and Technology Canada. 1991 Census of Canada. Catalogue number 92–310E.

    Google Scholar 

  19. 19.

    Clarke EA, Marrett LD, Kreiger N (1991) Cancer registration in Ontario: a computer approach. In: Jensen OM, Parkin DM, MacLennan R, Muir CS, Skeet RG, eds. Cancer Registration: Principles and Methods. IARC Scientific Publications No. 95. Lyon: International Agency for Research on Cancer, pp. 246–257.

    Google Scholar 

  20. 20.

    Robles SC, Marrett LD, Clarke EA, Risch HA (1988) An application of capture-recapture methods to the estimation of completeness of cancer registration. J Clin Epidemiol 41: 495–501.

    Google Scholar 

  21. 21.

    World Health Organization (1977) Ninth Revision Conference, 1975. Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, vol. 1. Geneva: World Health Organization.

    Google Scholar 

  22. 22.

    World Health Organization (1976) ICD-O. International Classification of Diseases for Oncology, 1st edn. Geneva: World Health Organization.

    Google Scholar 

  23. 23.

    Statistics Canada (1982) Census Divisions and Subdivisions — Population, Occupied Private Dwelling, Private Households, Census Families in Private Households Selected Characteristics. Ottawa: Supply and Services Canada, 1982. 1981 Census of Canada. Catalogue number 93-X-918 (E-564).

    Google Scholar 

  24. 24.

    Statistics Canada (1987) Population and Dwelling Characteristics-Census Divisions and Subdivisions Ontario: Part 1. Profiles. Ottawa: Supply and Services Canada. 1986 Census of Canada. Catalogue number 94–111.

    Google Scholar 

  25. 25.

    Statistics Canada (1992) Profile of Census Divisions and Subdivisions in Ontario, Part A. Ottawa: Industry, Science and Technology Canada. 1991 Census of Canada. Catalogue number 95–337.

    Google Scholar 

  26. 26.

    Statistics Canada (1992) 1991 Census Dictionary. Ottawa: Supply and Services Canada. 1991 Census of Canada. Catalogue number 92–301E.

    Google Scholar 

  27. 27.

    Hertz-Picciotto I (1998) Environmental epidemiology. In: Rothman KJ, Greenland S, eds. Modern Epidemiology, 2nd edn. Philadelphia: Lippincott-Raven, pp. 555–583.

    Google Scholar 

  28. 28.

    Sandler DP, Ross JA (1997) Epidemiology of acute leukemia in children and adults. Semin Oncol 24: 3–16.

    Google Scholar 

  29. 29.

    Westergaard T, Andersen PK, Pedersen JB, et al. (1997) Birth characteristics, sibling patterns, and acute leukemia risk in childhood: a population-based cohort study. J Natl Cancer Inst 89: 939–947.

    Google Scholar 

  30. 30.

    Greaves MF, Alexander FE (1993) An infectious etiology for common acute lymphoblastic leukemia in childhood? Leukemia 7: 349–360.

    Google Scholar 

  31. 31.

    Greaves MF (1997) Aetiology of acute leukaemia. Lancet 349: 344–349.

    Google Scholar 

  32. 32.

    Alexander FE, Cartwright RA, McKinney PA, Ricketts TJ (1990) Leukaemia incidence, social class and estuaries: an ecological analysis. J Public Health Med 12: 109–117.

    Google Scholar 

  33. 33.

    Petridou E, Kassimos D, Kalmanti M, et al. (1993) Age of exposure to infections and risk of childhood leukaemia. BMJ 307: 774.

    Google Scholar 

  34. 34.

    Petridou E, Trichopoulos D, Kalapothaki V, et al. (1997) The risk profile of childhood leukaemia in Greece: a nationwide case-control study. Br J Cancer 76: 1241–1247.

    Google Scholar 

  35. 35.

    Kaye SA, Robison LL, Smithson WA, Gunderson P, King FL, Neglia JP (1991) Maternal reproductive history and birth characteristics in childhood acute lymphoblastic leukemia. Cancer 68: 1351–1355.

    Google Scholar 

  36. 36.

    Kinlen LJ, Clarke K, Hudson C (1990) Evidence from population mixing in British New Towns 1946–85 of an infective basis for childhood leukaemia. Lancet 336: 577–582.

    Google Scholar 

  37. 37.

    Walter SD (1991) The ecologic method in the study of environmental health. II. Methodologic issues and feasibility. Environ Health Perspect 94: 67–73.

    Google Scholar 

  38. 38.

    Morgenstern H (1995) Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health 16: 61–81.

    Google Scholar 

  39. 39.

    Muirhead CR (1995) Childhood leukemia in metropolitan regions in the United States: a possible relation to population density? Cancer Causes Control 6: 383–388.

    Google Scholar 

  40. 40.

    Alexander FE, Boyle P, Carli P-M, et al. (1999) Population density and childhood leukaemia: Results of the EUROCLUS study. Eur J Cancer 35: 439–444.

    Google Scholar 

  41. 41.

    Li C-Y, Lin RS, Lin C-H. (1998) Urbanization and childhood leukaemia in Taiwan. Int J Epidemiol 27: 587–591.

    Google Scholar 

  42. 42.

    Hjalmars U, Gustafsson G. (1999) Higher risk for acute childhood lymphoblastic leukaemia in Swedish population centres 1973–94. Br J Cancer 79: 30–33.

    Google Scholar 

  43. 43.

    Draper GJ, ed. (1991) The Geographical Epidemiology of Childhood Leukaemia and Non-Hodgkin's Lymphomas in Great Britain, 1966–83. London: HMSO.

  44. 44.

    Langford IH, Bentham G. (1993) Epidemiology of childhood leukaemia. BMJ 307: 445–446.

    Google Scholar 

Download references

Author information

Affiliations

  1. Department of Community Health and Epidemiology, 2nd Floor Abramsky Hall, Queen's University, Kingston, Ontario, Canada, K7L 3N6

    Anita Koushik & Will D. King

  2. >Samuel Lunenfeld Research Institute, Toronto, Ontario, Canada

    John R. McLaughlin

Authors
  1. Anita Koushik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Will D. King
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John R. McLaughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Koushik, A., King, W.D. & McLaughlin, J.R. An ecologic study of childhood leukemia and population mixing in Ontario, Canada. Cancer Causes Control 12, 483–490 (2001). https://doi.org/10.1023/A:1011266413087

Download citation

  • age distribution
  • Canada
  • childhood leukemia
  • epidemiology
  • incidence
  • population mixing
  • urban–rural status