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Epidemiology

Number of siblings and survival from childhood leukaemia: a national register-based cohort study from Sweden

British Journal of Cancer volume 125, pages 112–118 (2021)Cite this article

Subjects

Abstract

Background

Previous studies suggest worse leukaemia survival for children with siblings, but the evidence is sparse, inconsistent and does not consider clinical factors. We explored the associations between number of siblings in the household, birth order and survival from childhood acute lymphoid leukaemia (ALL) and acute myeloid leukaemia (AML).

Methods

In this nationwide register-based study we included all children aged 1–14, diagnosed with ALL and AML between 1991–mid-2015 in Sweden (n = 1692). Using Cox regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) according to number of siblings and birth order, adjusting for known prognostic and sociodemographic factors.

Results

A tendency towards better ALL survival among children with one, or ≥2, siblings was observed, adjHRs (95% CI): 0.73 (0.49–1.10) and 0.63 (0.40–1.00), respectively. However, this was mainly limited to children with low risk profiles. An indication of better AML survival among children with siblings was seen, adjHRs (95% CI) 0.68 (0.36–1.29) and 0.71 (0.34–1.48) but diminished after adjusting for birth order.

Conclusion

Our results do not support previous findings that a larger number of siblings is associated with poorer survival. Inconsistencies might be explained by underlying mechanisms that differ between settings, but chance cannot be ruled out.

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Acknowledgements

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Authors and Affiliations

  1. Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Hanna Mogensen, Karin Modig, Mats Talbäck, Maria Feychting & Giorgio Tettamanti

  2. Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

    Friederike Erdmann

  3. Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France

    Friederike Erdmann

  4. Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

    Mats Heyman

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  1. Hanna Mogensen
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  7. Giorgio Tettamanti
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Contributions

G.T., M.F., K.M., H.M. designed this study. M.F. and M.H. acquired the data, H.M., M.T., G.T. did the data management and H.M. conducted the analyses with supervision from G.T., M.F., M.T. All authors contributed to the interpretation of the results. H.M. drafted the manuscript, all authors contributed to the revision of it and approved the final version. All authors take responsibility for the accuracy and integrity of the work.

Corresponding author

Correspondence to Hanna Mogensen.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Regional Ethical Review Board in Stockholm, Sweden, dnr 2011/634–31/4 and 2014/417–32, and did not require individual consent from participants. The study was performed in accordance with the Declaration of Helsinki.

Data availability

This study was conducted using register data from Statistics Sweden (https://www.scb.se/vara-tjanster/bestalla-mikrodata/), the Swedish National Board of Health and Welfare (https://bestalladata.socialstyrelsen.se/data-for-forskning/) and the Swedish Childhood Cancer Register (http://child3.ki.se/wordpress/index.php/for-vardpersonal-forskare/for-forskning/). These data are only available from each register holder after ethical review and secrecy assessment.

Competing interests

The authors declare no competing interests.

Funding information

This study was funded by the Swedish Research Council for Health, Working Life and Welfare contract no. 2013–1072.

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Mogensen, H., Modig, K., Talbäck, M. et al. Number of siblings and survival from childhood leukaemia: a national register-based cohort study from Sweden. Br J Cancer 125, 112–118 (2021). https://doi.org/10.1038/s41416-021-01374-1

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