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- Title
Cesarean Section and Risk of Childhood Acute Lymphoblastic Leukemia in a Population-Based, Record-Linkage Study in California.
- Authors
Rong Wang; Wiemels, Joseph L.; Metayer, Catherine; Morimoto, Libby; Francis, Stephen S.; Kadan-Lottick, Nina; DeWan, Andrew T.; Yawei Zhang; Xiaomei Ma
- Abstract
The relationship of mode of delivery to risk of childhood acute lymphoblastic leukemia (ALL) is uncertain. After linking birth records and cancer registry data from California, we conducted a population-based case-control study to investigate the role of delivery by cesarean section (C-section) in the etiology of childhood ALL. This study included 5,081 cases and 18,927 matched controls born in 1978-2009; more detailed data were available on type of C-section (i.e., elective vs. emergency) for a subset of 1,552 cases and 5,688 controls. No association was observed between C-section overall and childhood ALL risk (<15 years of age), but elective C-section was associated with a significantly elevated risk of ALL (odds ratio (OR) = 1.17, 95% confidence interval (CI): 1.01, 1.36). At the peak ages of ALL incidence (2-4 years), C-section was associated with an 11 % higher risk of ALL (OR = 1.11, 95% CI: 1.01, 1.22) compared with vaginal delivery, and the magnitude of the association was larger for elective C-section (OR = 1.38, 95% CI: 1.11, 1.70). Emergency C-section was not associated with childhood ALL. Because of design features minimizing nonparticipation and inaccurate recall, this record linkage-based study is less prone to bias. Our results suggest that delivery by elective C-section was associated with a higher risk of childhood ALL, especially at the peak ages of incidence. It is important to evaluate possible mechanisms, because this potential risk factor is modifiable.
- Subjects
CALIFORNIA; LYMPHOBLASTIC leukemia; ASIANS; BLACK people; CESAREAN section; CONFIDENCE intervals; HISPANIC Americans; RESEARCH funding; WHITE people; DISEASE incidence; CASE-control method; PARITY (Obstetrics); DATA analysis software; ODDS ratio; CANCER risk factors
- Publication
American Journal of Epidemiology, 2017, Vol 185, Issue 2, p96
- ISSN
0002-9262
- Publication type
Article
- DOI
10.1093/aje/kww153