Increased incidence of Hodgkin lymphoma with decreased association with Epstein-Barr virus in Taiwan: a shift toward Western style.

Abstract

Previous studies have reported a global increasing trend in the incidence of Hodgkin lymphoma (HL), especially among individuals who are female, of younger age and from Asian nations. However, detailed long-term trend analyses on individual countries and investigation of reasons for these temporal trends, including Epstein-Barr virus (EBV) association, are limited. We compared nationwide registration data from Taiwan and the USA during the interval 2001 through 2020 and used an age-period-cohort model to analyse individual effects of time period and birth cohort on the incidence trends. The incidence of HL in Taiwanese people was much lower than that in White Americans (7.39 vs 28.43 per million inhabitants). However, in contrast to a slightly decreased incidence rate in White Americans, HL in Taiwanese people showed a steadily increasing incidence rate during the 20-year interval (overall annual percentage change +2.82%), especially for women with nodular sclerosis subtype and aged 25-30 years, during the period 2011-2020. The prominent increase in relative risks was revealed by the time period and birth-cohort effects in Taiwanese people compared with White Americans. Interestingly, the linear trend test demonstrated a significant decrease in EBV association in Taiwanese HL over the 20-year period, from ∼60% to ∼20% (p=0.025), with a bimodal EBV-positive pattern in childhood (<10 years, 50%) and in older adults (>70 years, 93%). These findings suggest environmental influences and Westernisation of lifestyle in HL aetiology and that improvement of public health may influence the incidence and biological features of HL.