Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA; Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
Lancet Planet Health. 2024 Jul;8(7):e506-e514. doi: 10.1016/S2542-5196(24)00121-9.
High ambient temperature is increasingly common due to climate change and is associated with risk of adverse pregnancy outcomes. Acute lymphoblastic leukaemia is the most common malignancy in children, the incidence is increasing, and in the USA disproportionately affects Latino children. We aimed to investigate the potential association between high ambient temperature in pregnancy and risk of childhood acute lymphoblastic leukaemia.
We used data from California birth records (children born from Jan 1, 1982, to Dec 31, 2015) and California Cancer Registry (those diagnosed with childhood cancer in California from Jan 1, 1988, to Dec 31, 2015) to identify acute lymphoblastic leukaemia cases diagnosed in infants and children aged 14 years and younger and controls matched by sex, race, ethnicity, and date of last menstrual period. Ambient temperatures were estimated on a 1-km grid. The association between ambient temperature and acute lymphoblastic leukaemia was evaluated per gestational week, restricted to May-September, adjusting for confounders. Bayesian meta-regression was applied to identify critical exposure windows. For sensitivity analyses, we evaluated a 90-day pre-pregnancy period (assuming no direct effect before pregnancy), adjusted for relative humidity and particulate matter less than 2·5 microns in aerodynamic diameter, and constructed an alternatively matched dataset for exposure contrast by seasonality.
6849 cases of childhood acute lymphoblastic leukaemia were identified and, of these, 6258 had sufficient data for study inclusion. We also included 307 579 matched controls. Most of the study population were male (174 693 [55·7%] of the 313 837 included in the study) and of Latino ethnicity (174 906 [55·7%]). The peak association between ambient temperature and risk of acute lymphoblastic leukaemia was observed in gestational week 8, where a 5°C increase was associated with an odds ratio of 1·07 (95% CI 1·04-1·11). A slightly larger effect was seen among Latino children (OR 1·09 [95% CI 1·04-1·14]) than non-Latino White children (OR 1·05 [1·00-1·11]). The sensitivity analyses supported the results of the main analysis.
Our findings suggest an association between high ambient temperature in early pregnancy and risk of childhood acute lymphoblastic leukaemia. Further replication and investigation of mechanistic pathways might inform mitigation strategies.
Yale Center on Climate Change and Health, The National Center for Advancing Translational Science, National Institutes of Health.
由于气候变化，周围环境温度升高的情况越来越常见，这与不良妊娠结局的风险有关。急性淋巴细胞白血病是儿童中最常见的恶性肿瘤，其发病率正在上升，而且在美国，拉美裔儿童受其影响的比例不成比例。本研究旨在调查妊娠期间周围环境温度升高与儿童急性淋巴细胞白血病风险之间的潜在关联。
我们使用了加利福尼亚州出生记录（1982 年 1 月 1 日至 1985 年 12 月 31 日期间出生的儿童）和加利福尼亚癌症登记处（1988 年 1 月 1 日至 1985 年 12 月 31 日期间在加利福尼亚州被诊断为儿童癌症的患者）的数据，以确定在 14 岁及以下婴儿和儿童中诊断出的急性淋巴细胞白血病病例，并通过性别、种族、族裔和末次月经日期与对照组相匹配。周围环境温度以 1 公里的网格进行估计。在 5 月至 9 月期间，根据混杂因素进行调整，评估了每个妊娠周与急性淋巴细胞白血病之间的关联。应用贝叶斯元回归来确定关键的暴露窗口。作为敏感性分析，我们评估了妊娠前 90 天的暴露期（假设妊娠前没有直接影响），并根据相对湿度和空气动力学直径小于 2.5 微米的颗粒物进行了调整，同时构建了按季节性匹配的暴露对照数据集。
确定了 6849 例儿童急性淋巴细胞白血病病例，其中 6258 例有足够数据进行研究。我们还纳入了 307579 例匹配对照。研究人群中大多数为男性（313837 例纳入研究的人群中，有 174693 例[55.7%]）和拉丁裔（174906 例[55.7%]）。与急性淋巴细胞白血病风险之间的最大关联出现在妊娠第 8 周，此时周围环境温度升高 5°C，比值比为 1.07（95%CI 1.04-1.11）。在拉丁裔儿童（OR 1.09[95%CI 1.04-1.14]）中观察到的效果略大于非拉丁裔白种儿童（OR 1.05[1.00-1.11]）。敏感性分析结果支持主要分析的结果。
我们的研究结果表明，妊娠早期周围环境温度升高与儿童急性淋巴细胞白血病的风险之间存在关联。进一步的复制和对机制途径的研究可能会为缓解策略提供信息。
耶鲁大学气候变化与健康中心、国家转化医学推进中心、美国国立卫生研究院。
