Research Article

Evidence of population mixing based on the geographical distribution of childhood leukemia in Ohio†

  1. Brenda R. Clark MPH, MA1,*,
  2. Amy K. Ferketich PhD2,
  3. James L. Fisher PhD3,
  4. Frederick B. Ruymann MD4,
  5. Randall E. Harris MD, PhD2,
  6. John R. Wilkins III BCE, DrPH2

Article first published online: 15 MAR 2007

DOI: 10.1002/pbc.21181

Issue

Pediatric Blood & Cancer

Pediatric Blood & Cancer

Volume 49, Issue 6, pages 797–802, November 2007

Additional Information

How to Cite

Clark, B. R., Ferketich, A. K., Fisher, J. L., Ruymann, F. B., Harris, R. E. and Wilkins, J. R. (2007), Evidence of population mixing based on the geographical distribution of childhood leukemia in Ohio. Pediatric Blood & Cancer, 49: 797–802. doi: 10.1002/pbc.21181

Author Information

  1. 1

    Division of Health Behavior and Health Promotion, School of Public Health, The Ohio State University, Ohio

  2. 2

    Division of Epidemiology, School of Public Health, The Ohio State University, Ohio

  3. 3

    The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University, Ohio

  4. 4

    Division of Pediatric Hematology/Oncology, Columbus Children's Hospital, Columbus, Ohio

*The Ohio State University School of Public Health, 458 Cunz Hall, Voice: 614-247-7682, 1841 Millikin Road, Columbus, Ohio 43210.

  1. †

    Tha study was conducted at: The Ohio State University School of Public Health, M-150 Starling Loving Hall, 320 W. 10th Avenue, Columbus, OH 43210

Publication History

  1. Issue published online: 13 SEP 2007
  2. Article first published online: 15 MAR 2007
  3. Manuscript Accepted: 11 JAN 2007
  4. Manuscript Received: 6 JUN 2006

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Keywords:

  • acute lymphoblastic leukemia;
  • acute monocytic leukemia;
  • acute myelogenous leukemia;
  • cancer cluster;
  • pediatric leukemia;
  • population mixing

Abstract

Background

This ecologic study examined the geographic distribution of childhood leukemias in Ohio, 1996–2000, among children aged 0–19 for evidence that population mixing may be a factor.

Procedure

(1) State incidence rates were compared to Surveillance, Epidemiology and End Results (SEER) rates for each year and for the 5-year period, 1996–2000; (2) incidence rates for each of Ohio's 88 counties were compared to statewide rates; and (3) county incidence rates were compared based on population density, population growth, and rural/urban locale. SEER*Stat version 5.0 was used to derive age-specific and 0–19 age-adjusted rates. Expected values, standardized incidence ratios (SIRs), and Poisson P-values were calculated with Excel using the indirect method of standardization.

Results

Of the 585 cases, 73.3% were acute lymphocytic leukemia (ALL), 16.6% acute myelogenous leukemia (AML), 3.2% acute monocytic leukemia (AMoL), and 2.6% chronic myelogenous leukemia (CML). Rates for total leukemia burden were significantly below national levels for all races (P = 0.00001), likely due to poor ascertainment of cases. Yearly incidence rates for 1996–2000 were stable for ALL and AML; CML rates declined over the period. Based on 2000 Census and intercensal population estimates for 1996–2000, statistically higher rates for ALL were noted for counties experiencing >10% population change 1990–2000 (P < 0.05), especially for ages 1–4 (P < 0.03) in counties with 10–20% growth. Counties 67.9–99.2% urban experienced fewer than expected cases of AML + AMoL (P < 0.06).

Conclusion

Data support Kinlen's theory of population mixing and warrant further studies in Ohio, the US and other countries. Pediatr Blood Cancer 2007;49:797–802. © 2007 Wiley-Liss, Inc.

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