The association between birth order and childhood leukemia may be modified by paternal age and birth weight. Pooled results from the International Childhood Cancer Cohort Consortium (I4C)

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  • Ora Paltiel
  • Stanley Lemeshow
  • Gary S. Phillips
  • Gabriella Tikellis
  • Martha S. Linet
  • Anne Louise Ponsonby
  • Per Magnus
  • Siri E. Håberg
  • Sjurdur F. Olsen
  • Charlotta Granström
  • Mark Klebanoff
  • Jean Golding
  • Zdenko Herceg
  • Akram Ghantous
  • Jane Elizabeth Hirst
  • Arndt Borkhardt
  • Mary H. Ward
  • Signe Holst Søegaard
  • Terence Dwyer

The “delayed infection hypothesis” states that a paucity of infections in early childhood may lead to higher risks of childhood leukemia (CL), especially acute lymphoblastic leukemia (ALL). Using prospectively collected data from six population-based birth cohorts we studied the association between birth order (a proxy for pathogen exposure) and CL. We explored whether other birth or parental characteristics modify this association. With 2.2 × 10 6 person-years of follow-up, 185 CL and 136 ALL cases were ascertained. In Cox proportional hazards models, increasing birth order (continuous) was inversely associated with CL and ALL; hazard ratios (HR) = 0.88, 95% confidence interval (CI): (0.77–0.99) and 0.85: (0.73–0.99), respectively. Being later-born was associated with similarly reduced hazards of CL and ALL compared to being first-born; HRs = 0.78: 95% CI: 0.58–1.05 and 0.73: 0.52–1.03, respectively. Successive birth orders were associated with decreased CL and ALL risks (P for trend 0.047 and 0.055, respectively). Multivariable adjustment somewhat attenuated the associations. We found statistically significant and borderline interactions between birth weight (p = 0.024) and paternal age (p = 0.067), respectively, in associations between being later-born and CL, with the lowest risk observed for children born at <3 kg with fathers aged 35+ (HR = 0.18, 95% CI: 0.06–0.50). Our study strengthens the theory that increasing birth order confers protection against CL and ALL risks, but suggests that this association may be modified among subsets of children with different characteristics, notably advanced paternal age and lower birth weight. It is unclear whether these findings can be explained solely by infectious exposures.

OriginalsprogEngelsk
TidsskriftInternational Journal of Cancer
Vol/bind144
Udgave nummer1
Sider (fra-til)26-33
Antal sider8
ISSN0020-7136
DOI
StatusUdgivet - 2019
Eksternt udgivetJa

Bibliografisk note

Funding Information:
Key words: childhood leukemia, acute lymphoblastic leukemia, birth order, paternal age, birth weight, cohort studies Additional Supporting Information may be found in the online version of this article. Grant sponsor: NIH (NCI, NICHD)-USA; National Children’s Study-USA; Grant sponsor: Children’s Cancer Centre Foundation-Australia; Grant sponsor: Bluey Day Foundation-Australia; Grant sponsor: Baxter Family Foundation-Australia; Grant sponsor: The Rotary Club of North Brighton-Australia; Grant sponsor: Tour de Cure-Australia; Grant sponsor: Private philanthropic donations - Australia; Grant sponsor: Murdoch Children’s Research Institute, Australia; Grant number: M1300049; Grant sponsor: Research Council of Norway through its Centres of Excellence funding scheme, Trigon Foundation, Denmark, UK; Grant number: 262700; Grant sponsor: Medical Research Council and the Wellcome Trust ; Grant number: 092731; Grant sponsor: the University of Bristol currently provide core support for ALSPAC DOI: 10.1002/ijc.31635 History: Received 17 Dec 2017; Accepted 27 Apr 2018; Online 11 Aug 2018 Correspondence to: O. Paltiel, Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, POB 12000 Jerusalem, Israel 91120, Fax: 972-2-6449145, E-mail: orap@hadassah.org.il

Funding Information:
The Danish cancer cases were ascertained by the Danish Childhood Cancer Registry (Steering Committee: Catherine Rechnitzer, Peter Skov Wehner, Steen Rosth?j, and Henrik Schr?der). Disclosure: Gary Phillips received payment from Murdoch Children's Research Institute for statistical analysis. None of the other authors report a conflict of interest.

Publisher Copyright:
© 2018 UICC

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