Abstract
Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000–2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf’s circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.
Highlights
Leukemia is the most common childhood cancer worldwide [1]
This study aimed to identify clusters of acute childhood leukemia (ACL) cases, using a spatial analysis based on small geographical areas, and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000–2015
We identified the industrial sectors in proximity to the ACL clusters by identifying the industrial facilities located within a buffer of 1 km around the centroid of the “industrial conglomerates” that showed statistical significance of the distance variable in the multivariable model and were included within the spatio-temporal clusters identified for each city
Summary
According to the most recent report of the Global Cancer Observatory, it is estimated that 7745 new cases of leukemia were diagnosed in 2018 in Latin America and the Caribbean in children under 15 years old. In terms of mortality due to childhood leukemia, the Latin America and the Caribbean region has an estimated age-standardized mortality rate of 20 deaths per million children under 15 years old, the highest mortality rate for leukemia shared with the Asia region [2]. The estimated age-standardized incidence rate for leukemia in Colombia was 68.4 cases per million for children between 0 and 14 years old during 1992–2013 [4]. According to the long-term data of the population-based cancer registry of Cali, Colombia, the incidence of childhood leukemia had an annual percent change of 1.0 (95% confidence interval (CI): 0.2–1.8) between 1977 and 2011, while the mortality had an annual percent change of –1.2 (95% CI: −2.6–0.3) during the same time [5]
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