Time and spatial trends in lymphoid leukemia and lymphoma incidence and survival among children and adolescents in Manitoba, Canada: 1984-2013

<div><p>Objectives</p><p>To test for time and spatial trends in lymphoid malignancies, including lymphoid leukemia (LL), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL), in children and adolescents in the province of Manitoba, Canada.</p><p>Methods</p><p>Incident cases diagnosed between 1984 and 2013 were identified from the Manitoba Cancer Registry. We assessed time trends in age-standardized incidence rates using joinpoint regression and in 5-year relative survival using Poisson regression model. Kulldorff's scan method was used to assess spatial variation and clustering.</p><p>Results</p><p>Age-standardized incidence rates (per million person-years) in males and females were 34.0 (95% confidence interval [CI] 28.9–39.1) and 26.2 (95% CI 21.5–30.7) for LL, 10.5 (95% CI 7.7–13.3) and 12.5 (95% CI 9.4–15.7) for HL, 12.5 (95% CI 9.3–15.4) and 7.7 (95% CI 5.2–10.2) for NHL (except for Burkitt lymphomas), and 3.2 (95% CI 1.6–4.7) and 1.5 (95% CI 0.4–2.5) for Burkitt lymphomas. Age- and sex- standardized LL incidence rate increased 1.4% (95% CI 0.3%-2.5%) per year, while the changes for HL and NHL incidence rates were not statistically significant. There were geographic differences in age-standardized incidence rates for LL, HL, and NHL and spatial clusters were detected in southern part of the province. Five-year relative survival has improved over time and there was no difference between rural and urban areas.</p><p>Conclusions</p><p>Lymphoid leukemia incidence rate increased over time and varied by geographic area. Further research should examine the factors contributing to these trends.</p></div

Lymphoid leukemia and lymphoma cases diagnosed among children and adolescents in Manitoba: 1984–2013.

<p>Lymphoid leukemia and lymphoma cases diagnosed among children and adolescents in Manitoba: 1984–2013.</p

Age-standardized lymphoid leukemia and lymphoma incidence rates (per million person-years) in children and adolescents in Manitoba, Canada: 1984–2013.

<p>Age-standardized lymphoid leukemia and lymphoma incidence rates (per million person-years) in children and adolescents in Manitoba, Canada: 1984–2013.</p

Time trends for age- and sex-standardized lymphoid leukemia (a), Hodgkin lymphoma (b), and non-Hodgkin lymphoma (c) incidence in children and adolescents in Manitoba, Canada: 1984–2013.

<p>Time trends for age- and sex-standardized lymphoid leukemia (a), Hodgkin lymphoma (b), and non-Hodgkin lymphoma (c) incidence in children and adolescents in Manitoba, Canada: 1984–2013.</p

Time trends in 5-year relative survival of lymphoid leukemia and lymphoma in children and adolescents in Manitoba, Canada.

<p>Time trends in 5-year relative survival of lymphoid leukemia and lymphoma in children and adolescents in Manitoba, Canada.</p

Geographical variations in lymphoid leukemia (LL), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL) incidence in children and adolescents in Manitoba, Canada: 1984–2013.

<p>Geographical variations in lymphoid leukemia (LL), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL) incidence in children and adolescents in Manitoba, Canada: 1984–2013.</p

Estimates of the effectiveness (VE) of pandemic, seasonal influenza and pneumococcal vaccine against hospitalization with laboratory-confirmed influenza^*.

<p>*In these analyses, individuals vaccinated before the identified time duration considered unvaccinated</p><p>**Model A: Adjusted for age, gender, place of residence;</p><p>***Model B: Adjusted for Model A variables plus income, comorbidity, A(H1N1)pdm09 priority group, receiving the 2009/10 seasonal influenza vaccine, receiving a pneumococcal vaccine, immunosuppressed, pregnancy, ≥20 physician encounters in the last 5 years, ≥1 hospital admission in the last 5 years; use of antiviral prophylaxis and diagnosis of chronic renal failure.</p><p>^† Exact numbers between 1–5 are not reported as required by the data custodian to protect patient confidentiality.</p><p>Estimates of the effectiveness (VE) of pandemic, seasonal influenza and pneumococcal vaccine against hospitalization with laboratory-confirmed influenza^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0142754#t004fn001" target="_blank">*</a>}.</p

Estimates of the effectiveness (VE) of the adjuvanted A(H1N1)pdm09 vaccine (when received ≥14 days before the index date) against hospitalization due to influenza or pneumonia by certain demographic and clinical characteristics.

<p>*Defined as diagnosis with one of following diseases: diabetes, chronic obstructive pulmonary disease, asthma, ischemic heart disease, chronic renal failure, or cancer (excluding non-melanoma skin cancer).</p><p>**Model A: Adjusted for age, gender, place of residence;</p><p>***Model B: Adjusted for Model A variables plus income, comorbidity, A(H1N1)pdm09 priority group, receiving the 2009/10 seasonal influenza vaccine, receiving a pneumococcal vaccine, immunosuppressed, pregnancy, ≥20 physician encounters in the last 5 years, ≥1 hospital admission in the last 5 years; use of antiviral prophylaxis and diagnosis of chronic renal failure.</p><p>Estimates of the effectiveness (VE) of the adjuvanted A(H1N1)pdm09 vaccine (when received ≥14 days before the index date) against hospitalization due to influenza or pneumonia by certain demographic and clinical characteristics.</p

Demographic and clinical characteristics of cases and controls.

<p>SD: standard deviation.</p><p>* Defined as diagnosis with one of following diseases: diabetes, chronic obstructive pulmonary disease, asthma, ischemic heart disease, chronic renal failure, or cancer (excluding non-melanoma skin cancer).</p><p>Demographic and clinical characteristics of cases and controls.</p

Effect of NSAID ever-use in each exposure period (in years before the index date) on the risk of developing total prostate cancer by NSAID category.

<p>a) Adjusted for ever visited a urologist 1–11 years prior, SCREENED and volume of family physician visits in the 5 years prior to the index date, and to all terms listed in the table.</p