Dataset Information

Socioeconomic deprivation and regional variation in Hodgkin's lymphoma incidence in the UK: a population-based cohort study of 10 million individuals.

ABSTRACT:

Objectives

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.

Design

Population-based cohort study.

Setting

Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used.

Participants

Data on 10?million individuals in the UK from 1992 to 2016 were analysed.

Primary and secondary outcome measures

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.

Results

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).

Conclusions

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.

SUBMITTER: Rafiq M

PROVIDER: S-EPMC6756616 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Socioeconomic deprivation and regional variation in Hodgkin's lymphoma incidence in the UK: a population-based cohort study of 10 million individuals.

Rafiq Meena M Hayward Andrew A Warren-Gash Charlotte C Denaxas S S Gonzalez-Izquierdo Arturo A Lyratzopoulos Georgios G Thomas Sara S

BMJ open 20190920 9

<h4>Objectives</h4>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.<h4>Design</h4>Population-based cohort study.<h4>Setting</h4>Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multip ...[more]

PMID: 31542744

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Project description:BackgroundRecent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking.MethodsRecord-linkage cohort study of 1.93 million people to examine the association between small-area socioeconomic deprivation and 12 CVDs. Health records covered primary care, hospital admissions, a myocardial infarction registry and cause-specific mortality in England (CALIBER). Patients were aged ≥30 years and were initially free of CVD. Cox proportional hazard models stratified by general practice were used.FindingsDuring a median follow-up of 5.5 years 114,859 people had one of 12 initial CVD presentations. In women the hazards of all CVDs except abdominal aortic aneurysm increased linearly with higher small-area socioeconomic deprivation (adjusted HR for most vs. least deprived ranged from 1.05, 95%CI 0.83-1.32 for abdominal aortic aneurysm to 1.55, 95%CI 1.42-1.70 for heart failure; I2 = 81.9%, τ2 = 0.01). In men heterogeneity was higher (HR ranged from 0.89, 95%CI 0.75-1.06 for cardiac arrest to 1.85, 95%CI 1.67-2.04 for peripheral arterial disease; I2 = 96.0%, τ2 = 0.06) and no association was observed with stable angina, sudden cardiac death, subarachnoid haemorrhage, transient ischaemic attack and abdominal aortic aneurysm. Lifetime risk difference between least and most deprived quintiles was most marked for peripheral arterial disease in women (4.3% least deprived, 5.8% most deprived) and men (4.6% least deprived, 7.8% in most deprived); but it was small or negligible for sudden cardiac death, transient ischaemic attack, abdominal aortic aneurysm and ischaemic and intracerebral haemorrhage, in both women and men.ConclusionsAssociations of small-area socioeconomic deprivation with 12 types of CVDs were heterogeneous, and in men absent for several diseases. Findings suggest that policies to reduce deprivation may impact more strongly on heart failure and peripheral arterial disease, and might be more effective in women.

Project description:For Germany, regional differences for various health indicators, which are also associated with socioeconomic factors, have been documented. This article aims to develop a regional socioeconomic deprivation index for Germany that (1) can be used to analyse regional socioeconomic inequalities in health and (2) provides a basis for explaining regional health differences in Germany. The core data stem from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database compiled by Germany's Federal Institute for Research on Building, Urban Affairs and Spatial Development. Factor analysis is used for indexing and the weighting of indicators for the three dimensions of education, occupation and income. The German Index of Socioeconomic Deprivation (GISD) is generated at the levels of associations of municipalities, administrative districts and administrative regions for the years 1998, 2003, 2008 and 2012. Aggregate data and individual data from the German Health Update 2014/2015-EHIS (GEDA 2014/2015-EHIS) study are used to analyse associations between the index and selected health indicators. For around two thirds of the causes of death, the German Index of Socioeconomic Deprivation reveals significant socioeconomic inequalities at the level of Germany's administrative regions. At district level, life expectancy in the bottom fifth of districts presenting the highest levels of deprivation is, depending on the observation period, 1.3 years lower for women and 2.6 years lower for men in comparison to the upper fifth of districts presenting the lowest levels of deprivation. The index can explain 45.5% and 62.2% of regional differences in life expectancy for women and men, respectively. Moreover, the population in regions characterised by high levels of deprivation has significantly higher rates of smokers, engages less frequently in leisure-time physical activities and is more often obese. The German Index of Socioeconomic Deprivation illustrates regional socioeconomic differences at different spatial levels and contributes to explaining regional health differences. This index is intended for use in research as well as by federal and federal state health reporting systems and should enable access to new sources of data for investigating the links between social inequalities and health in Germany.

Dataset Information

Socioeconomic deprivation and regional variation in Hodgkin's lymphoma incidence in the UK: a population-based cohort study of 10 million individuals.

Objectives

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Socioeconomic deprivation and regional variation in Hodgkin's lymphoma incidence in the UK: a population-based cohort study of 10 million individuals.

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