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Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: A population-based cohort study of 10 million individuals

Rafiq, M; Hayward, A; Warren-Gash, C; Denaxas, S; Gonzalez-Izquierdo, A; Lyratzopoulos, G; Thomas, S; (2019) Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: A population-based cohort study of 10 million individuals. BMJ Open , 9 (9) , Article e029228. 10.1136/bmjopen-2019-029228. Green open access

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Abstract

Objectives: Hodgkin’s Lymphoma (HL) is the commonest 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 UK individuals from 1992–2016 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: 2,402 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% confidence interval 1.40–1.83), 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.

Type: Article
Title: Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: A population-based cohort study of 10 million individuals
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2019-029228
Publisher version: https://doi.org/10.1136/bmjopen-2019-029228
Language: English
Additional information: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Keywords: Hodgkin’s lymphoma; epidemiology; UK; deprivation; regional variation
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: https://discovery.ucl.ac.uk/id/eprint/10078127
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