title: Low Cloud Cover-Adjusted Ultraviolet B Irradiance Is Associated with High Incidence Rates of Leukemia: Study of 172 Countries.
abstract: There are 52,380 cases of leukemia and 24,090 deaths from it in the US annually. Its causes are unknown and no preventive strategies have been implemented. We hypothesized that leukemia is due mainly to vitamin D deficiency, which is due mainly to low solar ultraviolet B (UVB) irradiance. To test this hypothesis, we estimated age-standardized cloud-cover-adjusted winter UVB irradiance using cloud cover data from the International Satellite Cloud Climatology Project, latitudes of population centroids, and standard astronomical calculations. Incidence rates for 172 countries, available from the International Agency for Cancer Research, were plotted according to cloud-adjusted UVB irradiance. We used multiple regression to account for national differences in elevation and average life expectancy. Leukemia incidence rates were inversely associated with cloud-adjusted UVB irradiance in males (p ≤ 0.01) and females (p ≤ 0.01) in both hemispheres. There were few departures from the trend line, which was parabolic when plotted with the equator at the center of the display, northern hemisphere countries on the right side and southern hemisphere countries on the left. The bivariate association displayed by the polynomial trend line indicated that populations at higher latitudes had at least two times the risk of leukemia compared to equatorial populations. The association persisted in males (p ≤ 0.05) and females (p ≤ 0.01) after controlling for elevation and life expectancy. Incidence rates of leukemia were inversely associated with solar UVB irradiance. It is plausible that the association is due to vitamin D deficiency. This would be consistent with laboratory studies and a previous epidemiological study. Consideration should be given to prudent use of vitamin D for prevention of leukemia.
authors.affiliation: Division of Global Health, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America.|Graduate School of Public Health, San Diego State University, San Diego, California, United States of America.
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Cuomo
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America.
authors.forename: Cedric F
authors.initials: CF
authors.lastname: Garland
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Gorham
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America.
authors.forename: Sharif B
authors.initials: SB
authors.lastname: Mohr
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D012307:Risk Factors; D012727:Sex Characteristics; D014466:Ultraviolet Rays / Q000009:adverse effects*; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D014807:Vitamin D