Do pregnancy characteristics contribute to rising childhood cancer incidence rates in the United States?

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Abstract

Background: Since 1975, childhood cancer incidence rates have gradually increased in the United States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this study was to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order. We also considered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. Procedure: We conducted a time series county-level ecologic analysis using linked population-based data from Surveillance, Epidemiology, and End Results cancer registries (1975–2013), birth data from the National Center for Health Statistics (1970–2013), and sociodemographic data from the US Census (1970–2010). We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0–4 years, from Poisson mixed models. Results: There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC = 0.71%; 95% CI = 0.55–0.86), acute lymphoblastic leukemia (0.78%; 0.49–1.07), acute myeloid leukemia (1.86%; 1.13–2.59), central nervous system tumors (1.31%; 0.94–1.67), and hepatoblastoma (2.70%; 1.68–3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8% (hepatoblastoma) and 55% (combined). However, adjustment for other county characteristics did not attenuate AAPCs, and AAPCs remained significantly above 0% in models fully adjusted for county-level characteristics. Conclusion: Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends.

Original languageEnglish (US)
Article numbere26888
JournalPediatric Blood and Cancer
Volume65
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Pregnancy
Incidence
Maternal Age
Neoplasms
Hepatoblastoma
National Center for Health Statistics (U.S.)
Central Nervous System Neoplasms
Birth Order
Censuses
Poverty
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Registries
Epidemiology
Parturition
Population

Keywords

  • birth order
  • birthweight
  • childhood cancer
  • county-level incidence rates
  • ecologic time series analysis
  • maternal age

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

Cite this

@article{86bdd839ce7a4855a3198c746700eb47,
title = "Do pregnancy characteristics contribute to rising childhood cancer incidence rates in the United States?",
abstract = "Background: Since 1975, childhood cancer incidence rates have gradually increased in the United States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this study was to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order. We also considered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. Procedure: We conducted a time series county-level ecologic analysis using linked population-based data from Surveillance, Epidemiology, and End Results cancer registries (1975–2013), birth data from the National Center for Health Statistics (1970–2013), and sociodemographic data from the US Census (1970–2010). We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0–4 years, from Poisson mixed models. Results: There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC = 0.71{\%}; 95{\%} CI = 0.55–0.86), acute lymphoblastic leukemia (0.78{\%}; 0.49–1.07), acute myeloid leukemia (1.86{\%}; 1.13–2.59), central nervous system tumors (1.31{\%}; 0.94–1.67), and hepatoblastoma (2.70{\%}; 1.68–3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8{\%} (hepatoblastoma) and 55{\%} (combined). However, adjustment for other county characteristics did not attenuate AAPCs, and AAPCs remained significantly above 0{\%} in models fully adjusted for county-level characteristics. Conclusion: Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends.",
keywords = "birth order, birthweight, childhood cancer, county-level incidence rates, ecologic time series analysis, maternal age",
author = "Kehm, {Rebecca D.} and Osypuk, {Theresa L} and Jenny Poynter and Vock, {David M} and Spector, {Logan G}",
year = "2018",
month = "3",
day = "1",
doi = "10.1002/pbc.26888",
language = "English (US)",
volume = "65",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
publisher = "Wiley-Liss Inc.",
number = "3",

}

TY - JOUR

T1 - Do pregnancy characteristics contribute to rising childhood cancer incidence rates in the United States?

AU - Kehm, Rebecca D.

AU - Osypuk, Theresa L

AU - Poynter, Jenny

AU - Vock, David M

AU - Spector, Logan G

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: Since 1975, childhood cancer incidence rates have gradually increased in the United States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this study was to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order. We also considered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. Procedure: We conducted a time series county-level ecologic analysis using linked population-based data from Surveillance, Epidemiology, and End Results cancer registries (1975–2013), birth data from the National Center for Health Statistics (1970–2013), and sociodemographic data from the US Census (1970–2010). We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0–4 years, from Poisson mixed models. Results: There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC = 0.71%; 95% CI = 0.55–0.86), acute lymphoblastic leukemia (0.78%; 0.49–1.07), acute myeloid leukemia (1.86%; 1.13–2.59), central nervous system tumors (1.31%; 0.94–1.67), and hepatoblastoma (2.70%; 1.68–3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8% (hepatoblastoma) and 55% (combined). However, adjustment for other county characteristics did not attenuate AAPCs, and AAPCs remained significantly above 0% in models fully adjusted for county-level characteristics. Conclusion: Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends.

AB - Background: Since 1975, childhood cancer incidence rates have gradually increased in the United States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this study was to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order. We also considered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. Procedure: We conducted a time series county-level ecologic analysis using linked population-based data from Surveillance, Epidemiology, and End Results cancer registries (1975–2013), birth data from the National Center for Health Statistics (1970–2013), and sociodemographic data from the US Census (1970–2010). We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0–4 years, from Poisson mixed models. Results: There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC = 0.71%; 95% CI = 0.55–0.86), acute lymphoblastic leukemia (0.78%; 0.49–1.07), acute myeloid leukemia (1.86%; 1.13–2.59), central nervous system tumors (1.31%; 0.94–1.67), and hepatoblastoma (2.70%; 1.68–3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8% (hepatoblastoma) and 55% (combined). However, adjustment for other county characteristics did not attenuate AAPCs, and AAPCs remained significantly above 0% in models fully adjusted for county-level characteristics. Conclusion: Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends.

KW - birth order

KW - birthweight

KW - childhood cancer

KW - county-level incidence rates

KW - ecologic time series analysis

KW - maternal age

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DO - 10.1002/pbc.26888

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