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Am. J. Trop. Med. Hyg., 78(2), 2008, pp. 338-343
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Family Environment Is Associated with Endemic Burkitt Lymphoma: A Population-based Case-control Study

Jeanette J. Rainey, Rosemary Rochford, Peter O. Sumba, Dickens Kowuor, Mark L. Wilson, AND Ann M. Moormann*
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, Cleveland, Ohio

Endemic Burkitt’s lymphoma (eBL) has been linked to Epstein-Barr virus and holoendemic Plasmodium falciparum malaria. These co-infections, however, are insufficient to explain the non-random occurrence of Endemic Burkitt’s lymphoma within Equatorial Africa. To explore whether this distribution could be explained by household characteristics and family environment, we conducted a case-control study using 41 hospitalized incident endemic Burkitt’s lymphoma cases and 91 healthy controls identified through a population-based multistage cluster-sampling scheme in Nyanza Province, Kenya. In a multivariate analysis, odds ratios associated with having one, two, and three or more younger siblings compared with none were 0.28 (90% CI: 0.09, 0.83), 0.59 (90% CI: 0.16, 2.23) and 0.15 (90% CI: 0.03, 0.67) respectively, suggesting that children with endemic Burkitt’s lymphoma were more likely than controls to be last-born. Children with endemic Burkitt’s lymphoma were also more likely to live in non-monogamous families (OR=3.12, 90% CI:1.19, 8.17) and to have at least one deceased parent (OR=3.38, 90% CI: 1.18, 9.64). Household characteristics, especially sibship relationships, may contribute to endemic Burkitt’s lymphoma and therefore warrant further study.

Received April 10, 2007. Accepted for publication October 23, 2007.

Acknowledgments: The success of this project relied on the dedicated work of Juliana Otieno, Chief Pediatrician at Nyanza Provincial General Hospital, who diagnosed and treated the Burkitt’s cases included in this study. We also thank Dorine Omenah and Steve Obara at the Kenya Medical Research Institute in Kisumu, Kenya for their work in study participant recruitment and Brady West of the Center for Statistical Consultation and Research at the University of Michigan for his statistical advice. This manuscript was approved by the Director of the Kenya Medical Research Institute.

This project was supported by the Munn Idea Grant of the Comprehensive Cancer Center, Rackham Graduate School and the Center for Global Health at the University of Michigan, and from NIH Grant K08 AI051565 "Immunologic studies of endemic Burkitt’s lymphoma" (Moormann).

* Address correspondence to Ann M. Moormann, Center for Global Health and Diseases, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Wolstein Research Building 4-130, Cleveland OH, 44106-7286. E-mail: moorms{at}case.edu

Authors’ addresses: Jeanette J. Rainey, Global Immunization Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop E-05 1600 Clifton Road NE, Atlanta, GA 30333, Tel: (404) 639-8474, Fax: (404) 639-8676, E-mail: jkr7{at}cdc.gov. Rosemary Rochford, Department of Microbiology and Immunology, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, Tel: (315) 464-5468, Fax: (315) 464-4417, E-mail: rochforr{at}upstate.edu. Peter Odada Sumba, Center for Vector Biology & Control Research, Kenya Medical Research Institute PO Box 1578, Kisumu, Kenya, Tel: 254-57-202-2989, E-mail: POdada{at}kisian.mimcom.net. Dickens Kowuor, Center for Vector Biology & Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya, Tel: 254-57-202-2989, E-mail: DKowuor{at}kisian.mimcom.net. Mark L. Wilson, Global Health, Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory St., Room 2006, Ann Arbor, MI 48109-2029, Tel: (734) 936-0152, Fax: (734) 764-3192, E-mail: wilsonml{at}umich.edu. Ann M. Moormann, Center for Global Health & Diseases, Case Western Reserve University, 2103 Cornell Rd 4-130, Wolstein Research Building, Cleveland, OH 44106-7286, Tel: (216) 368-5144, Fax: (216) 368-4882, E-mail: moorms{at}case.edu.






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Copyright © 2008 by the American Society of Tropical Medicine and Hygiene.