title: Population mixing for leukaemia, lymphoma and CNS tumours in teenagers and young adults in England, 1996-2005.
abstract: BACKGROUND
  Little aetiological epidemiological research has been undertaken for major cancers occurring in teenagers and young adults (TYA). Population mixing, as a possible proxy for infectious exposure, has been well researched for childhood malignancies. We aimed to investigate effects of population mixing in this older age group using an English national cancer dataset.
  
  
  METHODS
  Cases of leukaemia, lymphoma and central nervous system (CNS) tumours amongst 15-24 year olds in England (diagnosed 1996-2005) were included in the study. Data were obtained by ward of diagnosis and linked to 1991 census variables including population mixing (Shannon index); data on person-weighted population density and deprivation (Townsend score) were also used and considered as explanatory variables. Associations between TYA cancer incidence and census variables were investigated using negative binomial regression, and results presented as incidence rate ratios (IRR) with 95% confidence intervals (CI).
  
  
  RESULTS
  A total of 6251 cases of leukaemia (21%), lymphoma (49%) and CNS tumours (30%) were analysed. Higher levels of population mixing were associated with a significant decrease in the incidence of CNS tumours (IRR=0.83, 95% CI=0.75-0.91), accounted for by astrocytomas and 'other CNS tumours'; however, there was no association with leukaemia or lymphoma. Incidence of CNS tumours and lymphoma was 3% lower in more deprived areas (IRR=0.97, 95% CI=0.96-0.99 and IRR=0.97, 95% CI=.96-0.98 respectively). Population density was not associated with the incidence of leukaemia, lymphoma or CNS tumours.
  
  
  CONCLUSIONS
  Our results suggest a possible role for environmental risk factors with population correlates in the aetiology of CNS tumours amongst TYAs. Unlike studies of childhood cancer, associations between population mixing and the incidence of leukaemia and lymphoma were not observed.
authors.forename: Marlous
authors.initials: M
authors.lastname: van Laar
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Stark
authors.forename: Patricia
authors.initials: P
authors.lastname: McKinney
authors.forename: Roger C
authors.initials: RC
authors.lastname: Parslow
authors.forename: Sally E
authors.initials: SE
authors.lastname: Kinsey
authors.forename: Susan V
authors.initials: SV
authors.lastname: Picton
authors.affiliation: Division of Epidemiology and Biostatistics, School of Medicine, Worsley Building, Clarendon Way, University of Leeds, Leeds LS2 9JT, UK. R.G.Feltbower@leeds.ac.uk.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Feltbower
mesh_terms: D000293:Adolescent; D000328:Adult; D016543:Central Nervous System Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000266:history; D002648:Child; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000453:epidemiology* / Q000209:etiology* / Q000266:history; D008223:Lymphoma / Q000453:epidemiology* / Q000209:etiology* / Q000266:history; D008297:Male; D055815:Young Adult