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. 2022 Apr 25;19(9):5232.
doi: 10.3390/ijerph19095232.

Exploring Blue Spaces' Effects on Childhood Leukaemia Incidence: A Population-Based Case-Control Study in Spain

Carlos Ojeda Sánchez  1 , Javier García-Pérez  2   3 , Diana Gómez-Barroso  3   4 , Alejandro Domínguez-Castillo  2 , Elena Pardo Romaguera  5 , Adela Cañete  5 , Juan A Ortega-García  6   7 , Rebeca Ramis  2   3   7
Affiliations

Exploring Blue Spaces' Effects on Childhood Leukaemia Incidence: A Population-Based Case-Control Study in Spain

Carlos Ojeda Sánchez et al. Int J Environ Res Public Health. .

Abstract

Background: Blue spaces have been a key part of human evolution, providing resources and helping economies develop. To date, no studies have been carried out to explore how they may be linked to paediatric oncological diseases.

Objectives: To explore the possible relationship of residential proximity to natural and urban blue spaces on childhood leukaemia.

Methods: A population-based case-control study was conducted in four regions of Spain across the period 2000-2018. A total of 936 incident cases and 5616 controls were included, individually matched by sex, year of birth and place of residence. An exposure proxy with four distances (250 m, 500 m, 750 m, and 1 km) to blue spaces was built using the geographical coordinates of the participants' home residences. Odds ratios (ORs) and 95% confidence intervals (95%CIs) for blue-space exposure were calculated for overall childhood leukaemia, and the acute lymphoblastic (ALL) and acute myeloblastic leukaemia (AML) subtypes, with adjustment for socio-demographic and environmental covariates.

Results: A decrease in overall childhood leukaemia and ALL-subtype incidence was found as we came nearer to children's places of residence, showing, for the study as a whole, a reduced incidence at 250 m (odds ratio (OR) = 0.77; 95%CI = 0.60-0.97), 500 m (OR = 0.78; 95%CI = 0.65-0.93), 750 m (OR = 0.80; 95%CI = 0.69-0.93), and 1000 m (OR = 0.84; 95%CI = 0.72-0.97). AML model results showed an increasing incidence at closest to subjects' homes (OR at 250m = 1.06; 95%CI=0.63-1.71).

Conclusions: Our results suggest a possible association between lower childhood leukaemia incidence and blue-space proximity. This study is a first approach to blue spaces' possible effects on childhood leukaemia incidence; consequently, it is necessary to continue studying these spaces-while taking into account more individualised data and other possible environmental risk factors.

Keywords: childhood cancer; childhood leukaemia; environmental factors; incidence; spatial epidemiology; urban blue spaces.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. This article presents independent research. The views expressed are those of the authors and not necessarily those of the Carlos III Institute of Health.

Figures

Figure 1
Figure 1
Spanish regions selected for the study.
Figure 2
Figure 2
Adjusted models’ graphical representations. Blue points represent ORs, blue-space exposure for each buffer distance compared to the reference group (subjects who did not have any blue space in their 1 km exposure buffers). Lower and upper 95%CIs are represented by orange points. (a) Overall childhood leukaemia, (b) ALL subtype, (c) AML subtype, (d) Cases with same address at birth and diagnosis, (e) cases <3 years old.
See this image and copyright information in PMC

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