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

Jeanette J. Rainey 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

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Rosemary Rochford 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

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Peter O. Sumba 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

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Dickens Kowuor 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

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Mark L. Wilson 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

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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

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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.

Author Notes

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