Article Text


The 5-minute Apgar score as a predictor of childhood cancer: a population-based cohort study in five million children
  1. Jiong Li1,
  2. Sven Cnattingus2,
  3. Mika Gissler3,
  4. Mogens Vestergaard4,5,
  5. Carsten Obel4,6,
  6. Jette Ahrensberg5,
  7. Jørn Olsen1,7
  1. 1Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
  2. 2Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
  3. 3National Institute for Health and Welfare, Helsinki, Finland/Nordic School of Public Health, Gothenburg, Sweden
  4. 4Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
  5. 5Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
  6. 6Research Program for Mental Child Health, Department of Public Health, Aarhus University, Aarhus, Denmark
  7. 7Department of Epidemiology, School of Public Health, University of California, Los Angeles, USA
  1. Correspondence to Dr Jiong Li; jl{at}


Objective The aetiology of childhood cancer remains largely unknown but recent research indicates that uterine environment plays an important role. We aimed to examine the association between the Apgar score at 5 min after birth and the risk of childhood cancer.

Design Nationwide population-based cohort study.

Setting Nationwide register data in Denmark and Sweden.

Study population All live-born singletons born in Denmark from 1978 to 2006 (N=1 771 615) and in Sweden from 1973 to 2006 (N=3 319 573). Children were followed up from birth to 14 years of age.

Main outcome measures Rates and HRs for all childhood cancers and for specific childhood cancers.

Results A total of 8087 children received a cancer diagnosis (1.6 per 1000). Compared to children with a 5-min Apgar score of 9–10, children with a score of 0–5 had a 46% higher risk of cancer (adjusted HR 1.46, 95% CI 1.15 to 1.89). The potential effect of low Apgar score on overall cancer risk was mostly confined to children diagnosed before 6 months of age. Children with an Apgar score of 0–5 had higher risks for several specific childhood cancers including Wilms’ tumour (HR 4.33, 95% CI 2.42 to 7.73).

Conclusions A low 5 min Apgar score was associated with a higher risk of childhood cancers diagnosed shortly after birth. Our data suggest that environmental factors operating before or during delivery may play a role on the development of several specific childhood cancers.

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.