Socioeconomic deprivation and regional variation in Hodgkin's lymphoma incidence in the UK: a population-based cohort study of 10 million individuals

Abstract

Objectives: Hodgkin's lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development.

Design: Population-based cohort study.

Setting: Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used.

Participants: Data on 10 million individuals in the UK from 1992 to 2016 were analysed.

Primary and secondary outcome measures: Poisson models were used to explore differences in HL incidence by age, sex, region and deprivation. Age-specific HL incidence rates by sex and directly age-standardised incidence rates by region and deprivation group were calculated.

Results: A total of 2402 new cases of HL were identified over 78 569 436 person-years. There was significant variation in HL incidence by deprivation group. Individuals living in the most affluent areas had HL incidence 60% higher than those living in the most deprived (incidence rate ratios (IRR) 1.60, 95% CI 1.40 to 1.83), with strong evidence of a marked linear trend towards increasing HL incidence with decreasing deprivation (p=<0.001). There was significant regional variation in HL incidence across the UK, which persisted after adjusting for age, sex and deprivation (IRR 0.80-1.42, p=<0.001).

Conclusions: This study identified high-risk regions for HL development in the UK and observed a trend towards higher incidence of HL in individuals living in less deprived areas. Consistent with findings from other immune-mediated diseases, this study supports the hypothesis that an affluent childhood environment may predispose to development of immune-related neoplasms, potentially through fewer immune challenges interfering with immune maturation in early life. Understanding the mechanisms behind this immune dysfunction could inform prevention, detection and treatment of HL and other immune diseases.

Keywords: Hodgkin’s lymphoma; UK; deprivation; epidemiology; regional variation.

Figure 1

Age-specific Hodgkin’s lymphoma incidence in the study population (cohort of the UK population): overall (left panel) and by sex (right panel), with 95% CI bars.

Figure 2

Age-standardised Hodgkin’s lymphoma incidence in the study population (cohort of the UK population) by region. PYAR, person-years at risk.

Figure 3

Age-standardised Hodgkin’s lymphoma incidence in the study population (cohort of the UK population) by deprivation: in men and women (left panel) and in individuals aged ≤50 compared with >50 (right panel). PYAR, person-years at risk.