大多数儿童癌症的病因在很大程度上是未知的。空间变化的环境因素,如交通相关的空气污染,背景辐射和农业杀虫剂可能有助于儿童癌症的发展。这项研究是首次使用居住地的精确地理代码对儿童癌症的空间疾病图谱进行调查。
我们纳入了瑞士儿童癌症登记处的5947名儿童,这些儿童在1985-2015年期间被诊断为癌症,年龄在0-15岁之间。我们使用对数高斯Cox过程和间接标准化来模拟癌症风险,以适应年龄和诊断年份。我们研究了风险的空间变化是否可以通过模拟NO2的环境空气浓度,模拟对背景电离辐射的暴露来解释,基于地区的社会经济地位(SEP),语言区域,各州一般癌症登记的年限或城市化程度。
对于所有儿童癌症,后位中位数相对风险(RR),与国家一级相比,不同的位置从0.83到1.13(最小到最大)。白血病的相应范围为0.96至1.09,淋巴瘤为0.90至1.13,中枢神经系统(CNS)肿瘤为0.82至1.23。考虑的协变量解释了所有癌症观察到的空间变异的72%,81%为白血病,82%为淋巴瘤,64%为CNS肿瘤。缺乏证据表明CNS肿瘤发病率与模拟暴露于背景电离辐射(每SD差异1.17;0.98-1.40的RR)和SEP(1.6;1.00-1.13)有关。
在被调查的诊断组中,儿童中枢神经系统肿瘤表现出最大的空间变异。选定的协变量仅部分解释了观察到的CNS肿瘤的变化,表明其他环境因素也起作用。
The aetiology of most childhood cancers is largely unknown. Spatially varying environmental factors such as traffic-related air pollution, background radiation and agricultural pesticides might contribute to the development of childhood cancer. This study is the first investigation of the spatial disease mapping of childhood cancers using exact geocodes of place of residence.
We included 5947 children diagnosed with cancer in Switzerland during 1985-2015 at 0-15 years of age from the Swiss Childhood Cancer Registry. We modelled cancer risk using log-Gaussian Cox processes and indirect standardisation to adjust for age and year of diagnosis. We examined whether the spatial variation of risk can be explained by modelled ambient air concentration of NO2, modelled exposure to background ionising radiation, area-based socio-economic position (SEP), linguistic region, duration in years of general cancer registration in the canton or degree of urbanisation.
For all childhood cancers combined, the posterior median relative risk (RR), compared to the national level, varied by location from 0.83 to 1.13 (min to max). Corresponding ranges were 0.96 to 1.09 for leukaemia, 0.90 to 1.13 for lymphoma, and 0.82 to 1.23 for central nervous system (CNS) tumours. The covariates considered explained 72% of the observed spatial variation for all cancers, 81% for leukaemia, 82% for lymphoma and 64% for CNS tumours. There was weak evidence of an association of CNS tumour incidence with modelled exposure to background ionising radiation (RR per SD difference 1.17; 0.98-1.40) and with SEP (1.6; 1.00-1.13).
Of the investigated diagnostic groups, childhood CNS tumours showed the largest spatial variation. The selected covariates only partially explained the observed variation of CNS tumours suggesting that other environmental factors also play a role.