title: South Asian ethnicity and material deprivation increase the risk of Epstein-Barr virus infection in childhood Hodgkin's disease.
abstract: In order to further define the factors associated with the observed variations in the Epstein-Barr virus-positive rate in childhood Hodgkin's disease, we have studied the effect of material deprivation (measured by the Townsend score) and ethnic origin on the frequency of Epstein-Barr virus-positivity in 55 cases of childhood Hodgkin's disease, diagnosed between 1981 and 1999, from a multi-ethnic region of the United Kingdom. Epstein-Barr virus status was determined by immunohistochemistry for the Epstein-Barr virus-encoded latent membrane protein-1. 62% of cases were Epstein-Barr virus-positive. Ethnic group was the strongest predictor of Epstein-Barr virus-positivity, with South Asians having a more than 20-fold risk of being Epstein-Barr virus-positive compared with non-South Asians. An increased risk was still present after adjusting for deprivation. Townsend scores were significantly higher (indicating more deprivation) in the Epstein-Barr virus-positive group, particularly in males. The relative risk of Epstein-Barr virus-positivity showed a gradient with increasing Townsend score; the risk being 7-times higher in the most deprived quartile compared with the least deprived group. Although the association between Townsend score and Epstein-Barr virus-positivity was reduced after adjusting for ethnic group, the risk of Epstein-Barr virus-positivity was still 3-times higher in the most deprived compared with the least deprived quartile. In addition, cases having 2 or more siblings were 5-times as likely to be Epstein-Barr virus-positive as those from smaller families. These results provide the first evidence of a strong association between Epstein-Barr virus-positive Hodgkin's disease and South Asian children from the United Kingdom. In addition, deprivation may increase the likelihood of Epstein-Barr virus-positive disease independently of ethnicity.
authors.affiliation: School of Health Sciences, University of Wolverhampton, Wolverhampton, WV1 1DJ.
authors.forename: K J
authors.initials: KJ
authors.lastname: Flavell
authors.forename: J P
authors.initials: JP
authors.lastname: Biddulph
authors.forename: J E
authors.initials: JE
authors.lastname: Powell
authors.forename: S E
authors.initials: SE
authors.lastname: Parkes
authors.forename: D
authors.initials: D
authors.lastname: Redfern
authors.forename: M
authors.initials: M
authors.lastname: Weinreb
authors.forename: P
authors.initials: P
authors.lastname: Nelson
authors.forename: J R
authors.initials: JR
authors.lastname: Mann
authors.forename: L S
authors.initials: LS
authors.lastname: Young
authors.forename: P G
authors.initials: PG
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000276:immunology; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004467:Economics; D020031:Epstein-Barr Virus Infections / Q000208:ethnology* / Q000821:virology; D005260:Female; D006689:Hodgkin Disease / Q000208:ethnology* / Q000821:virology; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014763:Viral Matrix Proteins / Q000276:immunology
chemical_list: D000956:Antigens, Viral; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D014763:Viral Matrix Proteins