title: Space-time clustering in childhood nervous system tumors in the Region of Murcia, Spain, 1998-2009.
abstract: OBJECTIVE
  The aims of this study are the following: first, to analyze incidence, trends, and survival of nervous system tumors in children under the age of 15 in the Region of Murcia, Spain, during the years 1998-2009 and second, to evaluate if certain environmental exposures may be involved in the etiology of childhood nervous system tumors. The study was performed on the spatial and temporo-spatial distribution of the observed cases.
  
  
  METHODS
  The Environment and Pediatric Cancer in the Region of Murcia is an ongoing research project aimed at carefully collecting pediatric environmental history (PEH) and to use geographical information systems to map the incidence and to analyze the geographical distribution of pediatric cancer incidence in our region. Between 1998 and 2009, 125 patients were diagnosed with nervous system tumors. The spatial and temporal space clusters were evaluated using Kulldorff's statistics. Address at diagnosis was the main feature evaluated.
  
  
  RESULTS
  The incidence (cases/million children) for central nervous system (CNS) tumors was 34.2, that for sympathetic nervous system tumors was 10.9, and that for retinoblastoma was 1.9. There was evidence of space clustering for medulloblastoma and space-time clustering for all tumors, CNS tumors, astrocytoma, and neuroblastoma.
  
  
  CONCLUSIONS
  The incidence and survival for each type and subtype of nervous system tumors were within the reported values for the European region. There is evidence that spatial and spatial-temporal distribution in these cases is not random. The development of a careful PEH in these patients will help to reinforce geographical information system studies and to ascertain the importance of associated risk factors.
authors.affiliation: Pediatric Environmental Health Specialty Unit, Translational Cancer Research Center, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, Spain. ortega@pehsu.org
authors.forename: Juan A
authors.initials: JA
authors.lastname: Ortega-García
authors.forename: Fernando A
authors.initials: FA
authors.lastname: López-Hernández
authors.forename: José L
authors.initials: JL
authors.lastname: Fuster-Soler
authors.forename: Juan F
authors.initials: JF
authors.lastname: Martínez-Lage
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D009423:Nervous System Neoplasms / Q000453:epidemiology*; D013029:Space-Time Clustering; D013030:Spain / Q000453:epidemiology