IJE Advance Access originally published online on August 31, 2006
International Journal of Epidemiology 2006 35(6):1504-1513; doi:10.1093/ije/dyl193
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Childhood leukaemia and socioeconomic status: fact or artefact? A report from the United Kingdom childhood cancer study (UKCCS)
1 Epidemiology and Genetics Unit, Department of Health Sciences, University of York, York YO10 5DD, UK.
2 Academic Centre for Defence Mental Health, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
3 Academic Unit of Paediatric Oncology, Christie Hospital and Central Manchester and Manchester Children's University Hospitals NHS Trusts, Manchester, M20 4BX, UK.
* Corresponding author. E-mail: alex.smith{at}egu.york.ac.uk
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Abstract |
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Background It is widely believed that children of high socioeconomic status (SES) are more likely than those of low SES to develop acute lymphoblastic leukaemia (ALL). Such observations have led to wide-ranging speculations about the potential aetiological role of factors associated with affluence and modernization.
Methods Children (0–14 years) newly diagnosed with cancer in the UK between 1991 and 1996 were ascertained via a rapid hospital-based case finding system (n = 4430, of which 1578 were ALL). Children without cancer (controls) were randomly selected from primary care population registries for comparative purposes (n = 7763). Area-based deprivation scores were assigned as markers of SES at two time points—birth and diagnosis. An individual-based marker of SES—social class—was assigned using father's occupation as recorded on the child's birth certificate.
Results No differences in area-based measures of deprivation were observed between cases and controls at time of diagnosis, either for all cancers combined [n = 4430, odds ratio (OR) = 1.00 (95% confidence intervals (CI) 0.98–1.01)] or for ALL alone (n = 1578 OR = 0.99, 95%CI 0.96–1.01). Findings were similar at time of birth (all cancers, OR = 0.99 95%CI 0.98–1.01, ALL OR = 0.98, 95%CI 0.96–1.00). In addition, no case-control differences were observed when an individual-based measure of SES—social class—based on father's occupation at time of birth was used.
Conclusions The comprehensive nature of the data, coupled with complete case-ascertainment and representative population-based controls suggests that SES in the UK is not a determinant of ALL in children. We believe the small effects reported for SES in some past studies may be artefactual.
Keywords bias, childhood cancer, childhood leukaemia, epidemiology, socioeconomic status
Accepted 27 July 2006
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