Table 3.
Postnatal exposure to environmental factors in relation to childhood acute lymphoblastic leukemia in their offspring, including strength of evidence, prevalence of the risk factors in Germany, and magnitude of risk (RR) with 95% confidence intervals.
| Authors | Study Design | Number of Study | Exposure Group | Exposure Type/Agent | * Evidence | Leukemia/Sub Type | † Prevalence | ‡ RR 95% CI |
|---|---|---|---|---|---|---|---|---|
| Sun et al., 2014 | Systematic review | 11 | Air pollution | Traffic density | Leukemia | 1.03, 0.98–1.09 | ||
| Filippini et al., 2019 | Systematic review | 16 | Traffic density | Leukemia | 1.09, 1.00–1.20 | |||
| 9 | Traffic density | ALL | 1.05, 0.96–1.16 | |||||
| 3 | Traffic density <6 years | Little | ALL | NA | 1.02, 0.99–1.05 | |||
| 7 | Nitrogen Dioxide | Leukemia | 1.04, 0.90–1.19 | |||||
| 4 | Nitrogen Dioxide | ALL | 1.02, 0.89–1.18 | |||||
| 2 | Nitrogen Dioxide children <6 years | No | ALL | High | 1.10, 0.92–1.32 | |||
| Filippini et al., 2015 | Systematic review | 4 | Chemicals | Proximity to petrol station | Leukemia | 1.83, 1.42–2.36 | ||
| Filippini et al., 2019 | Systematic review | 8 | Benzene | Leukemia | 1.27, 1.03–1.56 | |||
| 7 | Benzene | ALL | 1.09, 0.88–1.36 | |||||
| Benzene children < 6 years | Some | ALL | NA | 1.19, 1.00–1.40 | ||||
| Schuz et al., 2007 | Pooled analysis | 4 | Electromagnetic fields | ELF-MF (10:00 p.m.–6:00 a.m.) 0.1 ≤ 0.2 µT | Leukemia | 1.11, 0.91–1.36 | ||
| ELF-MF (10:00 p.m.–6:00 a.m.) 0.2 ≤ 0.4 µT | 1.37, 0.99–1.90 | |||||||
| ELF-MF (10:00 p.m.–6:00 a.m.) ≥ 0.4 µT | 1.93, 1.11–3.35 | |||||||
| ELF-MF 24-/48-h 0.1 ≤ 0.2 µT | 1.09, 0.89–1.32 | |||||||
| ELF-MF 24-/48-h 0.2 ≤ 0.4 µT | 1.20, 0.89–1.06 | |||||||
| ELF-MF24-/48-h ≥ 0.4 µT | 1.98, 1.18–3.35 | |||||||
| Ahlbom et al., 2000 | Pooled analysis | 9 | ELF-MF 0.1 ≤ 0.2 µT | Leukemia | 1.08, 0.88–1.32 | |||
| 9 | ELF-MF 0.2 ≤ 0.4 µT | 1.12, 0.84–1.51 | ||||||
| 9 | ELF-MF ≥ 0.4 µT | 2.08, 1.30–3.33 | ||||||
| 7 | ELF-MF 0.1 ≤ 0.2 µT | 1.07, 0.81–1.41 | ||||||
| 7 | ELF-MF 0.2 ≤ 0.3 µT | 1.16, 0.69–1.93 | ||||||
| 7 | ELF-MF ≥ 0.3 µT | 1.44, 0.88–2.36 | ||||||
| Greenland et al., 2000 | Pooled analysis | 12 | ELF-MF 0.1–0.2 µT—Wire Code Alone | Leukemia | 1.02, 0.81–1.29 | |||
| ELF-MF 0.2–0.3 µT—Wire Code Alone | 1.01, 0.69–1.48 | |||||||
| ELF-MF > 0.3 µT—Wire Code Alone | 1.38, 0.89–2.13 | |||||||
| Zhao et al., 2014 | Systematic review | 7 | ELF-MF 0.1 ≤ 0.2 µT | ALL | 1.09, 0.85–1.39 | |||
| ELF-MF 0.2 ≤ 0.4 µT | ALL | 1.04, 0.73–1.48 | ||||||
| ELF-MF ≥ 0.4 µT | ALL | 2.43, 1.30–4.55 | ||||||
| Greenland et al., 2000 | Pooled analysis | 12 | ELF-MF 2 µT | Leukemia | 1.08, 0.86–1.35 | |||
| ELF-MF 0.2–0.3 µT | 1.10, 0.76–1.60 | |||||||
| ELF-MF > 0.3 µT | 1.52, 0.99–2.33 | |||||||
| Amoon et al., 2021 | Pooled analysis | 4 | ELF-MF ≥ 0.4 μT | Leukemia | 1.01, 0.61–1.66 | |||
| ELF-MF 0.1 ≤ 0.2 μT | 1.10, 0.80–1.53 | |||||||
| ELF-MF 0.2 ≤ 0.4 μT | 0.75, 0.46–1.21 | |||||||
| Seomun et al., 2021 | Systematic review | 27 | ELF-MF 0.4µT | Some | Leukemia | Rare | 1.72, 1.25–2.35 | |
| Liu et al., 2011 | Systematic review | 7 | Lifestyle, behaviour, infection | Paternal smoking | High | 1.24, 0.96–1.60 | ||
| Chunxia et al., 2019 | Systematic review | 3 | Maternal smoking | Common | 0.84, 0.59–1.19 | |||
| Rudant et al., 2015 | Pooled analysis | 11 | Lifestyle, behaviour, infection | Breastfeeding | ALL | 0.95, 0.89–1.02 | ||
| Breastfeeding < 6 months | 1.01, 0.94–1.08 | |||||||
| Breastfeeding ≥ 6 months | 0.86, 0.79–0.94 | |||||||
| Breastfeeding | 0.95, 0.89–1.02 | |||||||
| Breastfeeding < 6 months | 1.01, 0.94–1.08 | |||||||
| Breastfeeding ≥ 6 months | 0.86, 0.79–0.94 | |||||||
| Martin et al., 2005 | Systematic review | 17 | Breastfeeding | 0.91, 0.84–0.98 | ||||
| Amitay et al., 2015 | Systematic review | 11 | Breastfeeding | 0.82, 0.73–0.93 | ||||
| Kwan et al., 2004 | Systematic review | 14 | Breastfeeding | High | 0.76, 0.68–0.84 | |||
| Urayama et al., 2010 | Systematic review | 9 | Lifestyle, behaviour, infection | Day-care attendance any time | 0.81, 0.70–0.94 | |||
| 11 | Day-care attendance at age ≤ 2 | 0.79, 0.65–0.95 | ||||||
| Rudant et al., 2015 | Pooled analysis | 11 | Day-care centre attendance at <1 year of age | 0.77, 0.71–0.84 | ||||
| 11 | Day-care centre attendance at <1 year of age | Some(inverse) | High | 0.77, 0.71–0.84 | ||||
| Orsi et al., 2018 | Pooled analysis | 13 | Lifestyle, behaviour, infection | Living on a farm | No | ALL | NA | 1.09, 0.86–1.36 |
| Orsi et al., 2018 | Pooled analysis | 13 | Lifestyle, behaviour, infection | Contact with any pets | Some(inverse) | ALL | 0.90, 0.84–0.96 | |
| Bailey et al., 2015b | Pooled analysis | 4 | Paint | Home paint-Any paint exposure | Some | B-lineage ALL | Rare | 1.22, 1.07–1.39 |
| Bailey et al., 2015a | Pooled analysis | 5 | General-Professional pest control treatments | B-lineage ALL | Modest | 1.28,1.14–1.45 | ||
| Van Maele-Fabry et al., 2019 | Systematic review | 8 | Pesticides | General | ALL | 1.42, 1.13–1.80 | ||
| 3 | General | 1.24, 0.90–1.70 | ||||||
| 3 | General-Indoor exposure | 1.19, 0.90–1.57 | ||||||
| 3 | General-Out door exposure | 1.27, 0.93–1.72 | ||||||
| Turner et al., 2010 | Systematic review | 4 | General | ALL | 1.40, 0.90–2.16 | |||
| Turner et al., 2010 | Systematic review | 3 | General-Indoor exposure | 1.56, 1.02–2.39 | ||||
| Turner et al., 2010 | Systematic review | 4 | General-Outdoor exposure | 1.40, 1.05–1.87 | ||||
| Chen et al., 2015 | Systematic review | 6 | General-Indoor | ALL | 1.59, 1.40–1.80 | |||
| Chen et al., 2015 | Systematic review | 6 | General-Outdoor | 1.15, 0.95–1.38 | ||||
| Chen et al., 2015 | Systematic review | 7 | General-Indoor pesticides-professional home | Some | Modest | 1.55, 1.38–1.75 | ||
| Chen et al., 2015 | Systematic review | 7 | Home pesticide | 1.46, 1.29–1.65 | ||||
| Chen et al., 2015 | Systematic review | 5 | Insecticides indoor | 1.59, 1.39–1.81 | ||||
| Bailey et al., 2015a | Pooled analysis | 12 | Home pesticide | 1.35, 1.21, 1.52 | ||||
| Bailey et al., 2015a | Pooled analysis | 5 | Household insecticide/miticide | Some | B-lineage ALL | Modest | 1.23, 1.12–1.34 | |
| Vinson et al., 2011 | Systematic review | 20 | Pesticides | Herbicides | Leukemia | 1.26, 1.14–1.39 | ||
| Vinson et al., 2011 | Systematic review | 45 | Insecticides | 1.17, 1.03–1.33 | ||||
| Bailey et al., 2015a | Pooled analysis | 5 | Insecticide or fungicide | B-lineage ALL | 1.41, 1.26–1.59 | |||
| Bailey et al., 2015a | Pooled analysis | 2 | Insect repellent (Personal) | 1.02, 0.86–1.20 | ||||
| Bailey et al., 2015a | Pooled analysis | 5 | Herbicide | 1.34, 1.21–1.48 | ||||
| Bailey et al., 2015a | Pooled analysis | 3 | Rodenticide | 1.32, 1.12–1.56 | ||||
| Bailey et al., 2015a | Pooled analysis | 3 | Molluscicide | B-lineage ALL | 1.06, 0.87–1.30 | |||
| Chen et al., 2015 | Systematic review | 9 | Insecticides-Outdoor | 1.11, 0.60–2.05 | ||||
| Chen et al., 2015 | Systematic review | 5 | Herbicides Outdoor | 1.26, 1.10–1.44 | ||||
| Van Maele-Fabry et al., 2019 | Systematic review | 3 | Insecticides | ALL | 1.19, 0.90–1.57 | |||
| Van Maele-Fabry et al., 2019 | Systematic review | 3 | Herbicides | 1.24, 0.96–1.60 | ||||
| Turner et al., 2010 | Systematic review | 3 | Insecticides | ALL | 1.35, 0.76–2.38 | |||
| Turner et al., 2010 | Systematic review | 4 | Herbicides | Some | Modest | 0.85, 0.43–1.66 | ||
| Bailey et al., 2015a | Pooled analysis | 6 | Pesticide used on pets | B-lineage ALL | NA | 1.15, 1.03–1.29 | ||
| Baker and Hoel, 2007 | Systematic review | 6 | Radiation | Proximity to nuclear facilities Incidence All | 1.25, 1.13–1.38 | |||
| 6 | Radiation | Proximity to nuclear facilities Incidence < 16 km | 1.23, 1.07–1.40 | |||||
| 6 | Radiation | Proximity to nuclear facilities Mortality All | 1.06, 1.01–1.11 | |||||
| 6 | Radiation | Proximity to nuclear facilities Mortality < 16 km | Some | Leukemia | Modest | 1.23, 1.04–1.46 | ||
| Lu et al., 2020 | Systematic review | 8 | Radiation | Domestic radon | 1.22, 1.01–1.42 | |||
| 2 | Radiation | Domestic radon | Conflicting | Leukemia | Moderate | 0.97, 0.81–1.15 | ||
| Little et al., 2018 | Systematic review | 7 | Radiation | Low doses of ionising radiation 5–9.99 mSv | ALL | 2.41, 0.64–8.65 | ||
| Radiation | Low doses of ionising radiation 10–19.99 mSv | 4.45, 1.50–14.08 | ||||||
| Radiation | Low doses of ionising radiation 20–49.99 mSv | 4.20, 1.35–13.28 | ||||||
| Radiation | Low doses of ionising radiation 50–100 mSv | 3.97, 0.97–14.15 | ||||||
| Radiation | Low doses of ionising radiation RR at 100 mSv | Strong | Modest | 5.66, 1.35–19.71 |
* Evidence category reflects those in the same rows by exposure type; † source of prevalence is different from RR data; ‡ RR also includes OR.