title: Ethnic variation in medical and lifestyle risk factors for B cell non-Hodgkin lymphoma: A case-control study among Israelis and Palestinians.
abstract: BACKGROUND
  Risk factors for B-cell non-Hodgkin lymphoma (B-NHL) have not been assessed among Palestinian Arabs (PA) and Israeli Jews (IJ).
  
  
  METHODS
  In a case-control study we investigated self-reported medical and lifestyle exposures, reporting odds ratios (ORs) and 95% confidence intervals [CIs], by ethnicity, for overall B-NHL and subtypes.
  
  
  RESULTS
  We recruited 823 cases and 808 healthy controls. Among 307 PA/516 IJ B-NHL cases (mean age at diagnosis = 51 [±17] versus 60 [±15] years, respectively) subtype distributions differed, with diffuse large B-cell lymphoma (DLBCL) being prominent among PA (71%) compared to IJ (41%); follicular lymphoma (FL), was observed in 14% versus 28%, and marginal zone lymphoma, in 2% versus 14%, respectively. Overall B-NHL in both populations was associated with recreational sun exposure OR = 1.43 [CI:1.07-1.91], black hair-dye use OR = 1.70 [CI:1.00-2.87], hospitalization for infection OR = 1.68 [CI:1.34-2.11], and first-degree relative with hematopoietic cancer, OR = 1.69 [CI:1.16-2.48]. An inverse association was noted with alcohol use, OR = 0.46 [CI:0.34-0.62]. Subtype-specific exposures included smoking (FL, OR = 1.46 [CI:1.01-2.11]) and >monthly indoor pesticide use (DLBCL, OR = 2.01 [CI:1.35-3.00]). Associations observed for overall B-NHL in PA only included: gardening OR = 1.93 [CI:1.39-2.70]; history of herpes, mononucleosis, rubella, blood transfusion (OR>2.5, P<0.01 for all); while for IJ risk factors included growing fruits and vegetables, OR = 1.87 [CI:1.11-3.15]; and self-reported autoimmune diseases, OR = 1.99 [CI:1.34-2.95].
  
  
  CONCLUSIONS
  In these geographically proximate populations we found some unique risk factors for B-NHL. Heterogeneity in the observed associations by ethnicity could reflect differences in lifestyle, medical systems, and reporting patterns, while variations by histology infer specific etiologic factors for lymphoma subtypes.
authors.affiliation: School of Public Health, Hadassah-Hebrew University Medical Organization, Jerusalem, Israel.
authors.forename: Geffen
authors.initials: G
authors.lastname: Kleinstern
authors.affiliation: Dept of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.|Faculty of Health Professions, Dept of Medical Laboratory Sciences, Al Quds University, Abu Deis, West Bank.
authors.forename: Rania
authors.initials: R
authors.lastname: Abu Seir
authors.affiliation: Dept of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Riki
authors.initials: R
authors.lastname: Perlman
authors.affiliation: Cancer Care Center, Augusta Victoria Hospital, East Jerusalem.
authors.forename: Areej
authors.initials: A
authors.lastname: Khatib
authors.affiliation: School Faculty of Medicine, Dept of Community Medicine, Al Quds University, Abu Deis, West Bank.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Abdeen
authors.affiliation: Beit Jalla Hospital, West Bank, PA.
authors.forename: Husein
authors.initials: H
authors.lastname: Elyan
authors.affiliation: Department of Statistics, Hebrew University, Jerusalem, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Nirel
authors.affiliation: Dept of Pathology, Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Gail
authors.initials: G
authors.lastname: Amir
authors.affiliation: Department of Primary Health Care, Ministry of Health, Ramallah, Palestine.
authors.forename: Asad
authors.initials: A
authors.lastname: Ramlawi
authors.affiliation: Cancer Care Center, Augusta Victoria Hospital, East Jerusalem.
authors.forename: Fouad
authors.initials: F
authors.lastname: Sabatin
authors.affiliation: Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, New York, United States of America.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Eldad J
authors.initials: EJ
authors.lastname: Dann
authors.affiliation: Chaim Sheba Medical Center, Tel Hashomer and Tel Aviv University, Israel.
authors.forename: Meirav
authors.initials: M
authors.lastname: Kedmi
authors.affiliation: Meir Medical Center, Kfar Saba, Israel.
authors.forename: Martin
authors.initials: M
authors.lastname: Ellis
authors.affiliation: Chaim Sheba Medical Center, Tel Hashomer and Tel Aviv University, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Dept of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Dina
authors.initials: D
authors.lastname: Ben Yehuda
authors.affiliation: School of Public Health, Hadassah-Hebrew University Medical Organization, Jerusalem, Israel.|Dept of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
mesh_terms: D000328:Adult; D000368:Aged; D018912:Arabs; D016022:Case-Control Studies; D005192:Family Health; D006202:Hair Dyes; D006801:Humans; D007557:Israel; D008019:Life Style; D016393:Lymphoma, B-Cell / Q000208:ethnology* / Q000209:etiology* / Q000235:genetics; D016403:Lymphoma, Large B-Cell, Diffuse / Q000208:ethnology / Q000209:etiology / Q000235:genetics; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013472:Sunlight
chemical_list: D006202:Hair Dyes