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Socioeconomic deprivation and regional variation in Hodgkin’s lymphoma incidence in the UK: a population-based cohort study of 10 million individuals
  1. Meena Rafiq1,
  2. Andrew Hayward2,
  3. Charlotte Warren-Gash3,
  4. S Denaxas1,
  5. Arturo Gonzalez-Izquierdo1,
  6. Georgios Lyratzopoulos4,
  7. Sara Thomas5
  1. 1 Institute of Health Informatics, University College London, London, UK
  2. 2 Institute of Epidemiology and Health Care, University College London, London, UK
  3. 3 Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare & Outcomes) Research Group, University College London, London, UK
  5. 5 Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Meena Rafiq; mrafiq{at}doctors.org.uk

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.

  • Hodgkin’s lymphoma
  • epidemiology
  • UK
  • deprivation
  • regional variation

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Footnotes

  • Contributors MR, AH, CW-G and ST contributed to the conception and design of the study, planning of analyses, interpretation of results and writing the manuscript. MR, SD and AG-I contributed to the planning of the analyses, extracting the data and performing the statistical analyses. GL contributed to study design and interpretation of results. All authors have read and approved the final manuscript.

  • Funding MR and the work presented in this paper are funded by the National Institute for Health Research (NIHR) in-practice clinical fellowship (IPF-2017-11-011). This article presents independent research funded by the NIHR. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. GL is supported by the Cancer Research UK Advanced Clinician Scientist Fellowship (C18081/A18180).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The protocol for this project was approved by the LSHTM Ethics Committee (ref:11182) and the ISAC for MHRA Database Research (protocol number:16_237). Generic ethical approval for observational studies conducted using anonymised CPRD data with approval from ISAC has been granted from a National Research Ethics Service Committee (NRESC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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