Environmental, social and behavioral risk factors in association with spatial clustering of childhood cancer incidence.
Anke H��ls, Sara Van Cor, Grace M Christensen, Zhenjiang Li, Yuxi Liu, Liuhua Shi, John L Pearce, Rana Bayakly, Timothy L Lash, Kevin Ward, Jeffrey M Switchenko
Author Information
Anke H��ls: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: anke.huels@emory.edu.
Sara Van Cor: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Grace M Christensen: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Zhenjiang Li: Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Yuxi Liu: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Liuhua Shi: Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
John L Pearce: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Rana Bayakly: Georgia Department of Public Health, Atlanta, GA, USA.
Timothy L Lash: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Kevin Ward: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Jeffrey M Switchenko: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Childhood cancer incidence is known to vary by age, sex, and race/ethnicity, but evidence is limited regarding external risk factors. We aim to identify harmful combinations of air pollutants and other environmental and social risk factors in association with the incidence of childhood cancer based on 2003-2017 data from the Georgia cancer Registry. We calculated the standardized incidence ratios (SIR) of Central Nervous System (CNS) tumors, leukemia and lymphomas based on age, gender and ethnic composition in each of the 159 counties in Georgia, USA. County-level information on air pollution, socioeconomic status (SES), tobacco smoking, alcohol drinking and obesity were derived from US EPA and other public data sources. We applied two unsupervised learning tools (self-organizing map [SOM] and exposure-continuum mapping [ECM]) to identify pertinent types of multi-exposure combinations. Spatial Bayesian Poisson models (Leroux-CAR) were fit with indicators for each multi-exposure category as exposure and SIR of childhood cancers as outcomes. We identified consistent associations of environmental (pesticide exposure) and social/behavioral stressors (low socioeconomic status, alcohol) with spatial clustering of pediatric cancer class II (lymphomas and reticuloendothelial neoplasms), but not for other cancer classes. More research is needed to identify the causal risk factors for these associations.
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