Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals
Objectives Hodgkin’s lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development.D...
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| Format: | Article |
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e029228.full |
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| author | Georgios Lyratzopoulos Sara Thomas Andrew Hayward Charlotte Warren-Gash Meena Rafiq S Denaxas Arturo Gonzalez-Izquierdo |
| author_facet | Georgios Lyratzopoulos Sara Thomas Andrew Hayward Charlotte Warren-Gash Meena Rafiq S Denaxas Arturo Gonzalez-Izquierdo |
| author_sort | Georgios Lyratzopoulos |
| collection | DOAJ |
| description | Objectives Hodgkin’s lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development.Design Population-based cohort study.Setting Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used.Participants Data on 10 million individuals in the UK from 1992 to 2016 were analysed.Primary and secondary outcome measures Poisson models were used to explore differences in HL incidence by age, sex, region and deprivation. Age-specific HL incidence rates by sex and directly age-standardised incidence rates by region and deprivation group were calculated.Results A total of 2402 new cases of HL were identified over 78 569 436 person-years. There was significant variation in HL incidence by deprivation group. Individuals living in the most affluent areas had HL incidence 60% higher than those living in the most deprived (incidence rate ratios (IRR) 1.60, 95% CI 1.40 to 1.83), with strong evidence of a marked linear trend towards increasing HL incidence with decreasing deprivation (p=<0.001). There was significant regional variation in HL incidence across the UK, which persisted after adjusting for age, sex and deprivation (IRR 0.80–1.42, p=<0.001).Conclusions This study identified high-risk regions for HL development in the UK and observed a trend towards higher incidence of HL in individuals living in less deprived areas. Consistent with findings from other immune-mediated diseases, this study supports the hypothesis that an affluent childhood environment may predispose to development of immune-related neoplasms, potentially through fewer immune challenges interfering with immune maturation in early life. Understanding the mechanisms behind this immune dysfunction could inform prevention, detection and treatment of HL and other immune diseases. |
| format | Article |
| id | doaj-art-1e809e5fca6843f7a27ceb72c6f9f75e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-1e809e5fca6843f7a27ceb72c6f9f75e2024-11-28T21:05:08ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-029228Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individualsGeorgios Lyratzopoulos0Sara Thomas1Andrew Hayward2Charlotte Warren-Gash3Meena Rafiq4S Denaxas5Arturo Gonzalez-Izquierdo64 Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare & Outcomes) Research Group, University College London, London, UKCwm Taf Public Health Team, Public Health Wales, Public Health Wales, Merthyr Tydfil, UKDepartment of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK1 Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UKEpidemiology of Cancer and Healthcare Outcomes (ECHO) Group, University College London, London, UKInstitute of Health Informatics, University College London, London, UKresearch associate epidemiologyObjectives Hodgkin’s lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development.Design Population-based cohort study.Setting Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used.Participants Data on 10 million individuals in the UK from 1992 to 2016 were analysed.Primary and secondary outcome measures Poisson models were used to explore differences in HL incidence by age, sex, region and deprivation. Age-specific HL incidence rates by sex and directly age-standardised incidence rates by region and deprivation group were calculated.Results A total of 2402 new cases of HL were identified over 78 569 436 person-years. There was significant variation in HL incidence by deprivation group. Individuals living in the most affluent areas had HL incidence 60% higher than those living in the most deprived (incidence rate ratios (IRR) 1.60, 95% CI 1.40 to 1.83), with strong evidence of a marked linear trend towards increasing HL incidence with decreasing deprivation (p=<0.001). There was significant regional variation in HL incidence across the UK, which persisted after adjusting for age, sex and deprivation (IRR 0.80–1.42, p=<0.001).Conclusions This study identified high-risk regions for HL development in the UK and observed a trend towards higher incidence of HL in individuals living in less deprived areas. Consistent with findings from other immune-mediated diseases, this study supports the hypothesis that an affluent childhood environment may predispose to development of immune-related neoplasms, potentially through fewer immune challenges interfering with immune maturation in early life. Understanding the mechanisms behind this immune dysfunction could inform prevention, detection and treatment of HL and other immune diseases.https://bmjopen.bmj.com/content/9/9/e029228.full |
| spellingShingle | Georgios Lyratzopoulos Sara Thomas Andrew Hayward Charlotte Warren-Gash Meena Rafiq S Denaxas Arturo Gonzalez-Izquierdo Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals BMJ Open |
| title | Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals |
| title_full | Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals |
| title_fullStr | Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals |
| title_full_unstemmed | Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals |
| title_short | Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals |
| title_sort | socioeconomic deprivation and regional variation in hodgkin s lymphoma incidence in the uk a population based cohort study of 10 million individuals |
| url | https://bmjopen.bmj.com/content/9/9/e029228.full |
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