title: Population-based study of lymphoma in Germany: rationale, study design and first results.
abstract: A multi-centre, population-based case-control study of lymphoma among adults was conducted in Germany from 1999-2003. The study comprised 700 incident cases (Hodgkin lymphomas and non Hodgkin's lymphoma, NHL) in the age range 18-80 years and 700 age-, sex- and area-matched controls obtained from population registries. Diagnosis was based on the REAL/WHO classification. Information on demographic characteristics, lifestyle, medical history and occupation was obtained by in-person interviews. Each participant was asked for a 24 ml blood sample. First results are focused on basic demographic characteristics, contact to animals, childhood diseases and vaccinations. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. The ORs for lymphoma were decreased for exposure to sheep and goats (OR = 0.7; 95% CI = 0.5-0.9), for rabbits and hare (OR = 0.7; 95% CI = 0.5-0.9), measles infection (OR = 0.6; 95% CI = 0.5-0.9), Bordetella pertussis infection (OR = 0.7; 95% CI = 0.6-0.95), and tetanus vaccination (OR = 0.5; 95% CI = 0.3-0.9). Increased risk of lymphoma was associated with exposure to cattle (OR = 1.3; 95% CI = 1.03-1.7) and immunization for tuberculosis (OR = 1.5; 95% CI = 0.997-2.4). The results of this study are partly consistent with the hygiene hypothesis. The inconsistencies of some of the findings with an explanation by the Th1/Th2 paradigm, however, warrant further research and may indicate that broader explanatory concepts are needed.
authors.affiliation: Deutsches Krebsforschungszentrum, Abteilung Klinische Epidemiologie, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. n.becker@dkfz-heidelberg.de
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Becker
authors.forename: Evelin
authors.initials: E
authors.lastname: Deeg
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nieters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016022:Case-Control Studies; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D007239:Infections / Q000150:complications; D016015:Logistic Models; D008223:Lymphoma / Q000453:epidemiology* / Q000209:etiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016176:T-Lymphocyte Subsets; D014611:Vaccination / Q000009:adverse effects