Epidemiological and Clinical Correlates of Leukemia Ascertained in a Multiethnic Cohort of Pakistan
Epidemiological and Clinical Correlates of Leukemia Ascertained in a Multiethnic Cohort of Pakistan
Rehana Yasmin1,2, Rashda Abbasi2*, Tariq Saeed2, Madiha Sadiq2, Nuzhat Yasmeen3, Muhammad Iqbal4, A. Khuzaim Alzahrani5, Nadeem Kizilbash5, Ugur Bilge6, Nafees Ahmad2 and Sajid Malik1*
ABSTRACT
Leukemia is one of the most prevalent cancers among pediatric malignancies and causes huge economic burden. In this case-control study epidemiological, environmental, life-style related risk factors and phenotypic characteristics of leukemia subtypes were investigated in Pakistani population. A total of 1500 subjects, including 616 patients and 884 controls were recruited through a retrospective cross-sectional sampling design. Descriptive summaries were generated, and risk factors were analyzed through logistic regression. We identified Pathan ethnicity (OR=2.85; 95%CI=2.29-3.54), no formal education (OR=3.36; 95%CI=2.62-4.32), poor diet (OR=2.34; 95%CI=1.79-3.06), lower BMI (OR=1.95; 95%CI=1.50-2.60), parental consanguinity (OR=2.13; 95%CI=1.67-2.71), positive family history (OR=4.24; 95%CI=2.18-8.26), rural residential setup (OR=2.93; 95%CI=2.10-4.10), drinking of groundwater (OR=2.25; 95%CI=1.6479-3.0964), wooden fuel (OR= 3.97; 95%CI=3.14-5.01), carbonated drinks (OR=1.25, 95%CI=1.00-1.57) and tobacco usage (OR=1.57, 95%CI=1.24-1.98) as significant risk factors for leukemia. However, odds ratios were significantly lower for patients using microwave oven (OR=0.25; 95%CI=0.18-0.35), and perfumes (OR=0.42; 95%CI=0.33-0.53). Males exhibit an increased risk for lymphoid leukemia as compared to myeloid leukemia (OR=1.97; 95%CI=1.38-2.80). Paraclinical parameters indicated that 71% of the cases had >50% of blast cells. Leukocytosis (OR= 9.06; 95% CI=6.46-12.71), anemia (OR= 15.84; 95% CI=11.84-21.21), low hemoglobin (OR=8.11; 95% CI=6.35-10.37), thrombocytopenia (OR=32.40; 95% CI=21.57-48.68), lymphocytosis (OR= 3.41; 95% CI=2.55-4.57), and neutropenia (OR=7.32; 95% CI=5.59-9.60) had significantly higher odd ratio for leukemia patients. Leukemia risk factors are mainly relevant to exposure due to rural residence, poor lifestyle, and family history of the disease. The disease incidence can be minimized by designing and implementing risk mitigation strategies.
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