Residential exposure to solar ultraviolet radiation and risk of childhood hematological malignancies in Switzerland: A census-based cohort study.

Abstract

Still little is known about possible environmental risk factors of childhood hematological malignancies (CHM). Previous studies suggest that ultraviolet radiation (UVR) exposure is associated with a lower risk of acute lymphoblastic leukemia (ALL) in children. We investigated the association between solar UVR exposure and risk of CHM in Switzerland, a country with greatly varying topography and weather conditions. We included all resident children aged 0-15 years from the Swiss National Cohort during 1990-2016 and identified incident cancer cases through probabilistic record linkage with the Swiss Childhood Cancer Registry. We estimated the overall annual mean UV level and the mean level for the month of July during 2004-2018 at children's homes using a climatological model of the midday (11 am-3 pm) UV-index (UVI) with a spatial resolution of 1.5-2 km. Using risk-set sampling, we obtained a nested case-control data set matched by birth year and fitted conditional logistic regression models (virtually equivalent to analyzing full cohort data using proportional hazards models) adjusting for sex, neighborhood socio-economic position, urbanization, air pollution, and background ionizing radiation. Our analyses included 1446 cases of CHM. Estimated adjusted hazard ratios (HR) per unit increase in UVI in July were 0.76 (95% CI 0.59-0.98) for leukemia and 0.74 (0.55-0.98) for ALL. Results for annual exposure were similar but confidence intervals were wider and included one. We found no evidence for an association for lymphoma overall (HR 1.14, 95% CI 0.59-2.19 for annual exposure) or diagnostic subgroups. Our study provides further support for an inverse association between exposure to ambient solar UVR and childhood ALL.