title: Family circumstances and survival from childhood acute lymphoblastic leukaemia in West Germany.
abstract: BACKGROUND
  Little is known about the relationship between family characteristics and survival from childhood acute lymphoblastic leukaemia (ALL), which we studied for the first time in German children.
  
  
  METHODS
  ALL cases were diagnosed between 1992 and 1994 and information on family characteristics was collected during a previously conducted nationwide case-control study. Children were followed for 10 years after diagnosis, as few disease-related events occur afterwards. Cox proportional hazards models estimating hazard ratios (HR) were calculated using overall as well as event-free survival methods.
  
  
  RESULTS
  Second born children showed statistically significant better survival compared to first or later born children, with HRs ranging between 0.54 and 0.64 compared to firstborns. Somewhat poorer survival was observed for children having 3 or more siblings. A relationship was found for parental age at child's diagnosis, with poorer survival for children with younger parents (≤25 years of age at child's diagnosis), or with older fathers. The HR was statistically significant for fathers being ≥41years of age (HR of 2.1). No relationship between degree of urbanization of the place of residence at diagnosis and ALL survival was observed.
  
  
  CONCLUSIONS
  Family circumstances may have an impact on survival from childhood ALL in Germany. Further research is warranted to elaborate the relationship of specific family characteristics and ALL survival and to investigate possible differential adherence to therapy and interactions with physicians.
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France. Electronic address: ErdmannF@students.iarc.fr.
authors.forename: Friederike
authors.initials: F
authors.lastname: Erdmann
authors.affiliation: German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 69, 55101 Mainz, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kaatsch
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schüz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001722:Birth Order; D002648:Child; D002675:Child, Preschool; D005195:Family Relations; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis
keywords: Birth order; Childhood acute lymphoblastic leukaemia; Family characteristics; Number of siblings; Parental age; Survival