Gianicolo Emilio, Russo Antonello, Di Staso Rossana, Ronckers Cécile M, Schmidtmann Irene, Wollschläger Daniel, Blettner Maria
Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
National Research Council, Institute of Clinical Physiology, Lecce, Italy.
Eur J Epidemiol. 2024 Dec;39(12):1373-1378. doi: 10.1007/s10654-024-01182-w. Epub 2024 Nov 26.
Increased incidence rates for childhood leukaemia have been reported in municipalities close to the nuclear power plant (NPP) Krümmel (Geesthacht, Germany). Methodological challenges arise when analysing this association at ecological level. They include the use of an appropriate reference population, unstable estimates of standardised incidence ratios (SIRs), and the potential role of prevailing winds. The aim of our study is to address these challenges. The German Childhood Cancer Registry provided data on leukaemia in children under 15 years (2004-2019). The German Federal Statistical Office provided the population data. The study region included all municipalities with ≥ 75% surface area within 50 kms from the Krümmel NPP. We calculated SIRs using national and regional reference rates. Smoothed incidence relative rates (IRRs) were calculated and mapped to check for potential patterns associated with prevailing winds. Overall 356 cases of childhood leukaemia were observed in the study region (321 municipalities) during 2004-2019. SIRs based on national reference rates show nearly no difference to those calculated using the regional rates as reference. Increased SIR and IRR were observed in Geesthacht (observed-cases = eight; SIR = 2.29; 95% confidence interval: 0.99-4.51. IRR = 1.80; 95% credibility interval: 0.88-2.79). The analysis of the IRR map does not show patterns associated with prevailing winds. Using a regional population as the reference, we found evidence that there may still be an increased risk for childhood leukaemia in Geesthacht. However, IRR estimates are uncertain and credibility intervals are compatible with the absence of elevated risk. The persistent evidence of risk of childhood leukaemia in Geesthacht warrants further epidemiological surveillance.
据报道，在德国盖斯特哈赫特市靠近克鲁默尔核电站（NPP）的一些城市中，儿童白血病的发病率有所上升。在生态层面分析这种关联时会出现方法学上的挑战。这些挑战包括使用合适的参考人群、标准化发病率比（SIRs）的不稳定估计以及盛行风的潜在作用。我们研究的目的是应对这些挑战。德国儿童癌症登记处提供了15岁以下儿童白血病的数据（2004 - 2019年）。德国联邦统计局提供了人口数据。研究区域包括距离克鲁默尔核电站50公里范围内所有表面积≥75%的城市。我们使用国家和地区参考率计算了SIRs。计算并绘制了平滑发病率相对率（IRRs），以检查与盛行风相关的潜在模式。2004 - 2019年期间，在研究区域（321个城市）共观察到356例儿童白血病病例。基于国家参考率的SIRs与使用地区率作为参考计算的结果几乎没有差异。在盖斯特哈赫特观察到SIR和IRR有所增加（观察到的病例数 = 8；SIR = 2.29；95%置信区间：0.99 - 4.51；IRR = 1.80；95%可信区间：0.88 - 2.79）。IRR地图分析未显示出与盛行风相关的模式。以地区人口作为参考，我们发现有证据表明盖斯特哈赫特儿童白血病的风险可能仍然增加。然而，IRR估计不确定，可信区间与不存在风险升高的情况相符。盖斯特哈赫特儿童白血病风险的持续证据值得进一步的流行病学监测。
