Socioeconomic differences in the risk of childhood central nervous system tumors in Denmark: a nationwide register-based
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ORIGINAL PAPER
Socioeconomic differences in the risk of childhood central nervous system tumors in Denmark: a nationwide register‑based case–control study Friederike Erdmann1,2 · Ulla Arthur Hvidtfeldt1 · Mette Sørensen1,3 · Ole Raaschou‑Nielsen1,4 Received: 21 April 2020 / Accepted: 24 July 2020 © The Author(s) 2020
Abstract Purpose Differences in the risk of childhood central nervous system (CNS) tumors by socioeconomic status (SES) may enhance etiologic insights. We conducted a nationwide register-based case–control study to evaluate socioeconomic differences in the risk of childhood CNS tumors in Denmark and examined whether associations varied by different SES measures, time points of assessment, specific tumor types, and age at diagnosis. Methods We identified all children born between 1981 and 2013 and diagnosed with a CNS tumor at ages 0–19 years (n = 1,273) from the Danish Cancer Registry and sampled four individually matched controls per case (n = 5,086). We used conditional logistic regression models to estimate associations with individual-level and neighborhood-level socioeconomic measures. Results We observed elevated risks of ependymoma and embryonal CNS tumors in association with higher parental education (odds ratios (ORs) of 1.6–2.1 for maternal or paternal high education and ependymoma) and higher risk of all tumor types in association with higher maternal income, e.g., OR 1.93; 95% CI 1.05–3.52 for high versus low income for astrocytoma and other gliomas. Associations were often stronger in children diagnosed at ages 5–19 years. We found little evidence for an association with neighborhood SES. Conclusion This large nationwide register study with minimal risk of bias showed that having parents with higher educational level and a mother with higher income was associated with a higher risk of childhood CNS tumors. Bias or underascertainment of cases among families with low income or basic education is unlikely to explain our findings. Keywords Tumors of the central nervous system · Childhood · Childhood cancer · Socioeconomic factors · Socioeconomic status · Denmark · Register-based study
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10552-020-01332-x) contains supplementary material, which is available to authorized users. * Friederike Erdmann friederike.erdmann@uni‑mainz.de 1
Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
2
Tumors of the central nervous system (CNS) are the most frequent solid tumors in children, accounting for around 20–25% of all cancers diagnosed in 0–19 year olds in highincome countries [1]. Its two most common subtypes in 3
Department of Natural Science and Environment, Roskilde University, Universit
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