Social class and age at diagnosis of Hodgkin's disease: new epidemiologic evidence for the "two-disease hypothesis".

The bimodality in the age-incidence pattern of Hodgkin's disease (HD) suggests that the disease may result from two causal pathways with differing age peaks. Among young adults, HD may develop as a rare consequence of a common infection (probably viral), with risk increasing with age at time of infection. However, among older persons, HD may result from other causes, probably similar to those of the other lymphomas. We evaluated this hypothesis in a population-based, case-control study in eastern Massachusetts involving 326 newly diagnosed cases (patients greater than or equal to 15 years of age) and 650 population controls. These subjects were compared for factors in childhood environment that influence age of exposure to common viruses, including sibship size, parental education, and type of housing. Among young adults (15-39 years of age), risk of HD was associated with small family size, single-family housing, and relatively high maternal education, consistent with the delayed infectious exposure hypothesis. Among middle-aged persons (40-54 years of age), a similar pattern of social class risk factors was present. However, among older persons (greater than or equal to 55 years of age), risk was not associated with social class; if anything, patients were of somewhat lower social class background than controls. These findings are consistent with the "two-disease hypothesis," in that social class risk factors differed between younger and older persons. These findings, coupled with other epidemiologic observations, suggest that the pathogenesis of HD among older persons is independent of that among younger persons.