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Number of births and cases of all, among boys and girls born between 1981-1997 and diagnosed before the end of 2002
Source publication
The aim of this study was to investigate seasonal trends in the incidence of acute lymphoblastic leukaemia (ALL) around the times of birth and diagnosis in children aged 0-4 years and also to examine gender specific effects. Children born in South Hungary during 1981-1997 were analysed. Registrations of first malignancies for children, diagnosed un...
Context in source publication
Citations
... Seasonal variations in hematological disorders have been largely reported by several epidemiological studies. [1][2][3][4][5][6][7][8][9][10] Although the etiology behind this could be due to environmental factors or infectious agent, significant seasonal variations have been revealed in many studies. 1,2 In particular, many recent studies have reported seasonal variations in hematological disorders such as aplastic anemia (AA), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and immune thrombocytopenic purpura (ITP). ...
... 6,7 In another study, among 15-to 24-year-old cancer patients, ALL was found higher in the month of October, while AML was found higher in November, whereas lower incidence of AML and ALL was observed in the month of April and May, respectively. 8 A childhood study of seasonality in leukemia has shown peaks of diagnosis in summer season, while in a study on adults, higher incidence was observed in winter season. 9,10 Another study has reported significantly higher incidence of primary ITP in spring season. 2 In developing country such as Pakistan, several determinants such as higher population density, and environmental factors have largely increased the burden of hematological malignancies. ...
Context
Author observed certain hematological disorders clustering in certain part of the year, however no authentic data or local study was found which covered these disorders in the context of seasonal variations.
Objectives
To assess the seasonal variations in hematological disorders among patients diagnosed based on bone marrow biopsy.
Design
We retrospectively reviewed the 10-year records of hematological disorders among patients from year 2006 to 2015.
Setting
The study was conducted at National Institute of Blood Disease and included patients who visited their clinics.
Patients and Other Participants
All cases of aplastic anemia (AA), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), immune thrombocytopenic purpura (ITP), and acute promyelocytic leukemia (APML) were categorized based on the seasons in which they were diagnosed such as winter (December-February), spring (March-May), southwest monsoon periods (June-September), and retreating monsoon period (October and November). SPSS and STATA were used for statistics. Inferential statistics were explored using the chi-square test for heterogeneity to evaluate seasonal variations. P-value <0.05 was taken as significant.
Study Outcome Measures
To assess the seasonal variations in hematological disorders among patients diagnosed based on bone marrow biopsy, who attended National Institute of Blood Diseases (NIBD) clinics during 2006 to 2015. Significant seasonal and yearly variations were detected in all diagnosis except the APML.
Results
A total of 1982 cases were reviewed. Men were predominantly higher (n = 1190, 60%) as compared to women (n = 792, 40%). Frequency of ALL was found to be higher (513, 25.9%), followed by ITP (504, 25.4%), AML (490, 24.7%), AA (396, 20%), while APML was observed in only 79 (4%) patients. Seasonal variations in the diagnosis of hematological disorders were observed (P-value < .001), except in APML diagnosis (P-value = .445). Significant seasonal variations were also detected in both genders.
Conclusion
The finding of this study has reported an increase in hematological disorders during 2006 to 2015. Particularly, most of the cases were reported in southwest monsoon period, whereas the least number of cases were reported in retreating period. Significant seasonal and yearly variations were detected in all diagnosis except the APML.
... Smith has suggested that a maternal infection transmitted to the foetus during pregnancy may lead to genetic instability responsible for the development of B-cell precursor acute lymphoblastic leukaemia (BCP-ALL) [9]. In the light of the hypothesis that infections play a role in the aetiology of childhood AL, several studies (in particular before year 2000) have investigated seasonal variations in childhood leukaemia by month of birth [10][11][12][13][14][15][16][17], month of diagnosis, or month of symptom onset [18][19][20][21][22] (Online Resource 1). If environmental factors with seasonal variations were actually involved in the occurrence of leukaemia, seasonality of childhood AL incidence rates could be expected. ...
... Several studies have investigated the seasonality of childhood leukaemia with respect to date of birth or date of diagnosis [10][11][12][13][14][15][16][17][18][19][20][21][22] (Online Resource 1). In all, the results were heterogeneous and provided weak evidence of seasonality of childhood leukaemia. ...
... Since 2007, research on childhood ALL seasonality by month of diagnosis has continued but the results remained inconsistent (Online resource 1). While no seasonality was evidenced in South Hungary [16] and UK [14,17], a seasonal pattern for ALL was suggested in three studies conducted in Finland [19], India [20] and South Korea [22] with a higher incidence in April-September (only for ALL aged 2-4 years), August-November and January diagnosis periods, respectively. The total number of cases included was however quite limited in most of those studies. ...
Background
Several studies have addressed the potential seasonality of childhood acute leukaemia (AL) without conclusive results. Using data from the National Registry of Childhood Cancers over 1990–2014 in mainland France, we investigated the seasonal variations in childhood AL taken together, and lymphoblastic (ALL) and myeloid (AML) leukaemia separately.Methods
Assuming constant variations over 1990–2014, we used a Poisson regression model to evaluate variations in standardized incidence ratios (SIRs) by month of birth or diagnosis. A scan method for temporal cluster detection was used to identify windows of several consecutive months with high or low SIR. The yearly reproducibility of the observed monthly variations was then evaluated.ResultsWe included 11,528 AL, of which 9493 ALL and 1,843 AML. No seasonal variation was detected for ALL. With a clear seasonal pattern, differences in AML incidence rates were evidenced between January–April and May–December birth periods (SIR = 0.85, 95% CI 0.77–0.94 and SIR = 1.07, 95% CI 1.01–1.14, respectively). AML incidence variations by month of diagnosis were less clear-cut.Conclusion
Based on a large number of cases from a high-quality registry, we did not evidence any seasonality in ALL incidence rates but evidenced seasonal variations in AML incidence rates by month of birth.
... Seasonal variations in hematological disorders have been largely reported by several epidemiological studies. [1][2][3][4][5][6][7][8][9][10] Although the etiology behind this could be due to environmental factors or infectious agent, significant seasonal variations have been revealed in many studies. 1,2 In particular, many recent studies have reported seasonal variations in hematological disorders such as aplastic anemia (AA), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and immune thrombocytopenic purpura (ITP). ...
... 6,7 In another study, among 15-to 24-year-old cancer patients, ALL was found higher in the month of October, while AML was found higher in November, whereas lower incidence of AML and ALL was observed in the month of April and May, respectively. 8 A childhood study of seasonality in leukemia has shown peaks of diagnosis in summer season, while in a study on adults, higher incidence was observed in winter season. 9,10 Another study has reported significantly higher incidence of primary ITP in spring season. 2 In developing country such as Pakistan, several determinants such as higher population density, and environmental factors have largely increased the burden of hematological malignancies. ...
Aims:
To assess the seasonal variations in hematological disorders among patients diagnosed on the basis of bone marrow biopsy, who attended National Institute of Blood Diseases (NIBD) clinics during 2006 to 2015.
Methods:
We retrospectively reviewed the 10-year records of hematological disorders among patients' NIBD clinics from year 2006 to 2015. All cases of aplastic anemia (AA), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), immune thrombocytopenic purpura (ITP), and acute promyelocytic leukemia (APML) were categorized on the basis of the seasons in which they were diagnosed such as winter (December-February), spring (March-May), southwest monsoon periods (June-September), and retreating monsoon period (October and November). Statistical analysis was performed by using SPSS and STATA. Inferential statistics were explored using the chi-square test for heterogeneity to evaluate seasonal variations. P-value <0.05 was taken as significant.
Results:
A total of 1982 cases were reviewed. Men were predominantly higher (n = 1190, 60%) as compared to women (n = 792, 40%). Frequency of ALL was found to be higher (513, 25.9%), followed by ITP (504, 25.4%), AML (490, 24.7%), AA (396, 20%), while APML was observed in only 79 (4%) patients. Seasonal variations in the diagnosis of hematological disorders were observed (P-value < .001), except in APML diagnosis (P-value = .445). Significant seasonal variations were also detected in both genders in stratified analysis.
Conclusion:
The finding of this study has reported an increase in the hematological disorder during 2006 to 2015. Particularly, majority of the cases were reported in southwest monsoon period, whereas least cases were reported in retreating period. Significant seasonal and yearly variations were detected in all diagnosis except the APML.
... The goodness-of-fit test statistic was 1.18 (p = 0.946). These findings with the Walter-Elwood method are similar to our published results from southern Hungary (Nyári et al., 2008). ...
Our study demonstrates the use of the Walter-Elwood method in double-peak seasonal variation. The concept of the geometrical model for analysing cyclic variation is described. Monte Carlo simulation procedures are used to compare the performance of the Walter-Elwood and negative binomial regression methods with double-peak seasonality, in both a comparison between the two methods and a power analysis. The results of 10,000 independent Monte Carlo simulations showed that the Walter-Elwood method and the negative binomial regression analysis identified the same peak in 9,956 samples, indicating that the power of both methods is similar in analysing double-peak cyclic trends. Additionally, two epidemiological applications of double-peak seasonality are presented, which were analysed using the Walter-Elwood method. Further, this is the first study to describe the power of the Walter-Elwood method for double peak seasonality. In conclusion, double-peak seasonality could be investigated with the Walter-Elwood method in ecological studies when only the population at risk is available and there is no other variable.
... Infectious etiologies have been hypothesized for both ALL and AML (9) because of the high incidence of these cancers in early childhood, coinciding with common early infections and immune system immaturity (10). This hypothesis has been supported for ALL by some (11)(12)(13)(14)(15) but not all (16)(17)(18) studies reporting associations with season of birth, a proxy for perinatal infectious exposures. However, season of birth has rarely been studied in relation to AML risk, and has never been examined in large population-based cohort studies with the potential to provide more robust and generalizable risk estimates. ...
Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973-2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June-August), incidence rate ratios for AML were 1.72 (95 % CI 1.25-2.38; P = 0.001) for winter (December-February), 1.37 (95 % CI 0.99-1.90; P = 0.06) for spring (March-May), and 1.27 (95 % CI 0.90-1.80; P = 0.17) for fall (September-November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML.
... The month distribution for the initial onset of ALL symptoms found a peak presentation in July, overall and in each of the genders (Fig. 3), indicating that seasonality may affect the morbidity of ALL. However, controversy remains over the effect of seasonal factors in the incidence, diagnosis and treatment of ALL (7,24,29). Gao et al (12) performed an international survey in Singapore, the USA and Sweden to provide evidence for the seasonal diagnosis of ALL. It was concluded that little evidence exsisted for a seasonal influence on ALL diagnosis. ...
The aim of the present study was to compare the clinical characteristics of acute lymphoblastic leukemia (ALL) that occurred in male and female patients at one institution in Southern China. The medical electronic records of Nanfang Hospital, affiliated to Southern Medical University, were searched for patients with a definite diagnosis of ALL that were diagnosed between January 1, 2001 and December 31, 2012. The clinical data of the patients were collected and analyzed. A total of 705 eligible patients were identified. The gender ratio of male to female patients was 1.84:1. The average ages at the time of diagnosis were 16.43 and 19.54 years for male and female patients, respectively (P=0.007). No significant differences were identified in the seasonal occurrence distribution, blood group distribution or ratio for the presence of the Ph chromosome between males and females. However, a higher incidence of T-cell type ALL was identified in males (P=0.023). The present study reveals that ALL demonstrates a male predominance, but similar clinical characteristics of ALL are present in males and females in Southern China.
... Nevertheless, age between 1 and 6 years and age between 2 and 6 years were used for sensitivity analyses. Furthermore, sensitivity analyses were carried out to test the models using the period of time used in our previous studies between 1981 and 1998 [11][12][13]. A p-value less than 0.05 was considered significant. ...
... In an earlier study different seasonal variation in boys and girls were found in South Hungary where the peaks were in February and in November, respectively [11]. Also different risk was detected in a study of population mixing, where in a gender-specific analysis the higher level of population mixing increased the risk of ALL in boys only [12]. ...
Our aim was to investigate the ecological association between death from infectious disease of the respiratory system and the risk of acute lymphoid leukaemia (ALL) in children aged less than 7 years. Poisson regression analyses were carried out using overall data and gender-specific models. The study included 176 cases (92(52.3 %) boys and 84 (47.7 %) girls) of ALL in those aged 0-6 years in South Hungary. Eight cases were diagnosed before the age of 1 year. A significant risk of ALL disease was observed with higher levels of mortality from the chronic respiratory diseases (p = 0.035) and pneumonia (p = 0.010) among children aged 2-5 years (Odds Ratio for trend was 1.001 and 95%CI [1.000-1.002] and Odds ratio for trend was 1.013 and 95%CI [1.003-1.023], respectively). Significantly increased risk of childhood ALL was detected among children under 1 year of age residing in areas around birth with higher levels of mortality from influenza (Odds Ratio (OR) for trend was 1.05; 95%CI [1.01-1.09]; p = 0.012). This risk was also detected in girls (p < 0.001), but not in boys (p = 0.43). Our findings provide new evidence that will help to understand the different pattern of female and male childhood ALL occurrence , but further studies are needed using detailed individual medical history to clarify the role of influenza and other infectious diseases in the etiology of childhood ALL and to explain gender-specific effects.
... Previous reports on the influence of season on childhood leukemia have not been consistent. Four studies have suggested seasonal variation in births for leukemia, and 3 of the 4 have suggested that the birth peak occurs in late winter or spring [February (26), March (27), and April (28)], whereas the fourth suggested 2 distinct peaks in February and August (29). The variation seen in previous studies may be because of variations between community burden of infections between countries or variation in timing of infection seasons from year to year. ...
Background:
Epidemiologic studies indicate that infections in early childhood may protect against pediatric acute lymphoblastic leukemia (ALL).
Methods:
We identified 3,402 ALL cases among children 0 to 5 years of age using the California Cancer Registry. From California birth records we randomly selected controls in a 20:1 ratio and frequency matched them to cases by birth year. We investigated markers of exposure to infections, including month of birth, timing of birth in relation to influenza and respiratory syncytial virus (RSV) seasons, and birth order based on data from California birth certificates and national infection surveillance systems.
Results:
We observed an increased risk of ALL for spring and summer births, and for those first exposed to an influenza or RSV season at nine to twelve months of age compared with those exposed during the first three months of life, and this association was stronger among first born children [odds ratios (OR), 1.44 and 95% confidence intervals (CI), 1.13-1.82, for influenza exposure at nine to twelve months of age]. Decreased risk was observed with increasing birth order among non-Hispanic whites but not Hispanics (OR, 0.76 and 95% CI, 0.59-096, for fourth or higher birth order among whites).
Conclusion:
Our results support the hypothesis that infections in early childhood decrease risk of ALL.
Impact:
Our findings implicate early life exposure to infections as protective factors for ALL in young children.
... Previous research has shown evidence for seasonality around the time of birth in relation to childhood cancer. For example, children diagnosed with acute lymphoblastic leukaemia aged 1-6 years in the North of England exhibited seasonality of birth, with peaks in February and March, [6,7] and a study from Hungary showed seasonality of birth amongst 0-4 year olds with ALL with peaks in February and August [8]. In contrast, several studies found no evidence of seasonality for ALL or by diagnostic group amongst children [9,10]. ...
We aimed to examine evidence for an infectious aetiology among teenagers and young adults (TYA) by analysing monthly seasonality of diagnosis and birth amongst 15--24 year olds diagnosed with cancer in England.
Cases of leukaemia, lymphoma and central nervous system (CNS) tumours were derived from the national TYA cancer register (1996--2005). Incidence rates (IR) and trends were assessed using Poisson regression. Seasonality of diagnosis and birth was assessed using Poisson and logistic regression respectively with cosine functions of varying periods.
There were 6251 cases diagnosed with leukaemia (n = 1299), lymphoma (n = 3070) and CNS tumours (n = 1882), the overall IR was 92 (95% CI 89--96) per 1,000,000 15--24 year olds per year.There was significant evidence of seasonality around the time of diagnosis for Hodgkin's lymphoma (P < 0.001) with a peak in February, and for 'other CNS tumours' (P = 0.010) with peaks in December and June. Birth peaks for those with 'other Gliomas' (Gliomas other than Astrocytoma and Ependymoma) were observed in May and November (P = 0.015).
Our novel findings support an infectious aetiological hypothesis for certain subgroups of TYA cancer in England. Further work will examine correlation with specific infections occurring around the time of birth and diagnosis within certain diagnostic groups.
... [2][3][4][5][6][7] Previous studies have investigated the possibility of seasonal variation in incidence of cancer by month of birth or diagnosis, but there has been inconsistency in findings. Evidence of seasonal variation by month of birth or diagnosis has been reported for childhood leukaemia, [8][9][10] lymphoma, 8,[11][12][13][14] and central nervous system (CNS) tumours. [15][16][17][18][19] Other studies have not found any seasonal patterns. ...
... 21,22 The study of seasonality of month of birth of childhood ALL in Hungary found different seasonal patterning for boys and girls with two peaks in February and August for boys and one peak in November for girls. 10 Studies of seasonal variation in month of diagnosis have shown inconsistent results. Some studies have reported a summer peak, 8,23,39 others an autumn/ winter peak, 9,40 or no seasonality in incidence by month of diagnosis for childhood ALL. ...
... Some studies have reported a summer peak, 8,23,39 others an autumn/ winter peak, 9,40 or no seasonality in incidence by month of diagnosis for childhood ALL. 10,20 Lymphoma and in particular HL in girls showed marked evidence of seasonality for month of diagnosis (peaks in March and January, respectively). The latter finding was based on small numbers and must be interpreted cautiously. ...
Basta NO, James PW, Craft AW, McNally RJQ. Season of birth and diagnosis for childhood cancer in Northern England, 1968–2005. Paediatric and Perinatal Epidemiology 2010; 24: 309–318.
The aim of this study was to investigate seasonal variation in the incidence of cancer in children aged 0–14 years. Details of 2959 primary malignant cases (1659 males, 1300 females), diagnosed during the period 1968–2005, were extracted from a specialist registry (the Northern Region Young Persons' Malignant Disease Registry). Seasonal variation was analysed with respect to month of birth and diagnosis. The chi-squared heterogeneity test was used to test for non-uniform variation. Poisson regression analysis was used to fit sinusoidal (harmonic) models to the data, using month of birth and month of diagnosis, respectively, as covariates in separate models.
There was significant sinusoidal variation based on month of birth for acute lymphoblastic leukaemia (ALL) aged 1–6 years (P = 0.04; peak in March). For 0- to 14-year-old boys, there was statistically significant sinusoidal variation in month of birth for acute non-lymphocytic leukaemia (P = 0.04; peak in September) and astrocytoma (P = 0.03; peak in October). Based on month of diagnosis, there was statistically significant sinusoidal variation in girls for all lymphomas (P = 0.048; peak in March) and Hodgkin lymphoma (HL) (P = 0.005; peak in January), and in boys for osteosarcoma (P = 0.049; peak in October). This study confirms previous findings of seasonal variation around the month of birth for childhood ALL (at the peak ages) and provides further evidence of seasonal variation around month of birth for astrocytoma and around month of diagnosis for HL. The results are consistent with a role for environmental factors in the aetiology of these diagnostic groups. Further studies are needed to examine putative candidate agents.
