Rafiq Meena, Hayward Andrew, Warren-Gash Charlotte, Denaxas S, Gonzalez-Izquierdo Arturo, Lyratzopoulos Georgios, Thomas Sara
Institute of Health Informatics, University College London, London, UK
Institute of Epidemiology and Health Care, University College London, London, UK.
BMJ Open. 2019 Sep 20;9(9):e029228. doi: 10.1136/bmjopen-2019-029228.
Hodgkin's lymphoma (HL) is the the most common 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.
Population-based cohort study.
Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used.
Data on 10 million individuals in the UK from 1992 to 2016 were analysed.
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.
A total of 2402 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% CI 1.40 to 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).
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.
霍奇金淋巴瘤（HL）是青少年和青年中最常见的癌症。这项在英国进行的为期25年的全国性研究调查了HL发病率在年龄、性别、地区和贫困程度方面的差异，以确定HL发病的趋势和高危人群。
基于人群的队列研究。
使用了与医院事件统计数据和多重贫困指数数据相链接的临床实践研究数据链（CPRD）电子初级保健记录。
分析了1992年至2016年英国1000万人的数据。
使用泊松模型探讨HL发病率在年龄、性别、地区和贫困程度方面的差异。计算了按性别划分的特定年龄HL发病率以及按地区和贫困组划分的直接年龄标准化发病率。
在78569436人年中，共确定了2402例新的HL病例。贫困组之间的HL发病率存在显著差异。生活在最富裕地区的个体HL发病率比生活在最贫困地区的个体高60%（发病率比（IRR）为1.60，95%置信区间为1.40至1.83），有强有力的证据表明随着贫困程度降低HL发病率呈明显的线性上升趋势（p<0.001）。英国各地的HL发病率存在显著的地区差异，在调整年龄、性别和贫困程度后这种差异仍然存在（IRR为0.80 - 1.42，p<0.001）。
本研究确定了英国HL发病的高危地区，并观察到生活在贫困程度较低地区的个体HL发病率有上升趋势。与其他免疫介导疾病的研究结果一致，本研究支持这样的假设：富裕的童年环境可能通过减少早期生活中干扰免疫成熟的免疫挑战，从而使个体易患免疫相关肿瘤。了解这种免疫功能障碍背后的机制可为HL及其他免疫疾病的预防、检测和治疗提供依据。
