J Epidemiol Community Health 2000;54:907-911 ( December )

Research report

Delayed infection, family size and malignant lymphomas P Vineis^a, L Miligi^b, P Crosignani^c, A Fontana^d, G Masala^b, O Nanni^e, V Ramazzotti^f, S Rodella^g, E Stagnaro^h, R Tuminoⁱ, C Viganò^c, C Vindigni^j, A Seniori Costantini^b

^a Servizio di Epidemiologia dei Tumori, Ospedale S Giovanni Battista e Università di Torino, via Santena 7, I-10123 Torino, Italy, ^b Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy, ^c National Cancer Institute, Milano, Italy, ^d Local Health Unit, Novara, Italy, ^e Istituto Oncologico Romagnolo, Forlì, Italy, ^f Cancer Registry, Latina, Italy, ^g Local Health Unit, Verona, Italy, ^h National Cancer Institute, Genova, Italy, ⁱ Cancer Registry, Ragusa, Italy, ^j Department of Pathology, University of Siena, Italy

Correspondence to: Dr Vineis (paolo.vineis{at}unito.it)

Accepted for publication 14 June 2000

BACKGROUNDThe annual incidence of non-Hodgkin's lymphomas (NHL) is increasing by 3%-4% in different parts of the developed world. Excesses of NHL have been observed in populations exposed to immunosuppressants and to HIV, but these causes do not explain the increasing trends. It is suggested that delayed infection could explain NHL trends, through an impairment of the Th1/Th2 lymphocyte patterns.
METHODSIn a population-based study on 1388 patients with NHL, 354 with Hodgkin's disease (HD) and 1718 healthy controls, the age of first occurrence of bacterial and viral diseases was investigated. Clinical records were perused in one centre to check the anamnestic data.
FINDINGSThe age of occurrence of bacterial and viral diseases was significantly higher among NHL patients than in the controls. The association between later age at first bacterial or viral disease was limited to small families (OR= 1.95; 95% confidence intervals 1.26, 3.00, for age 4-8 at first infection; OR=1.91; 1.19, 3.06, for age 9+, compared with less than 4). The association was more obvious for bacterial diseases (possibly for the lower degree of misclassification). High grade lymphomas showed the strongest association. The later age of occurrence of bacterial or viral diseases in NHL patients is consistent with a higher incidence of lymphomas observed in higher social groups. No clear association was found between HD and age at first bacterial or viral diseases.
INTERPRETATIONIt is proposed that delayed infection could explain the increasing NHL trends, through an impairment of the Th1/Th2 lymphocyte patterns. The model of delayed infection has been proposed also to explain increasing prevalence rates of asthma.

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© 2000 by Journal of Epidemiology and Community Health
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