Background

There is limited evidence that nitrate, a common contaminant in drinking water, increases the risk of childhood cancers. Our objective was to examine this association in Denmark.

Methods

We conducted a nationwide case-control study based on all singletons liveborn to Danish-born parents from 1991 to 2015 (N = 1,219,140) that included 596 leukemias, 180 lymphomas, and 310 central nervous system cancers (CNC) who were ≤15 years of age at diagnosis and were identified from the Danish Cancer Registry. Approximately 100 controls were randomly selected and matched to each case on date of birth and sex. Nitrate measurements in public water systems were linked with an address registry to estimate individual average nitrate concentrations during preconception, prenatal, and postnatal periods. Odd ratios (OR) and 95% confidence intervals (95%CI) were estimated using conditional logistic regression controlling for the matching variables, and birth order, birthweight, urbanicity, maternal education, employment, income and smoking, and parental age.

Results

There was no evidence of an association of nitrate with leukemia or lymphoma. An association between CNC and the highest category of nitrate exposure (>25 mg/L nitrate) was observed for preconception (OR = 1.82, 95%CI:1.09 to 3.04), prenatal (OR = 1.65, 95%CI:0.97 to 2.81), and postnatal exposure (OR = 1.48, 95%CI:0.82 to 2.68) in fully-adjusted models. There was also some evidence of an exposure–response in models of continuous nitrate exposure and CNC.

Conclusions

Our findings provide some evidence that exposure to nitrate from drinking water may increase the risk of childhood CNC cancer, but not leukemia or lymphoma.

中文翻译：

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丹麦从饮用水中接触硝酸盐和患儿童癌症的风险

背景

有限的证据表明硝酸盐是饮用水中的一种常见污染物，会增加儿童患癌症的风险。我们的目标是在丹麦检查这个协会。

方法

我们基于 1991 年至 2015 年丹麦出生的父母的所有活产单胎（N = 1,219,140）进行了一项全国性病例对照研究，其中包括 596 例白血病、180 例淋巴瘤和 310 例中枢神经系统癌症 (CNC)，这些患者年龄≤15 岁。诊断时的年龄，并从丹麦癌症登记处确定。大约 100 名对照被随机选择并与每个病例的出生日期和性别相匹配。公共供水系统中的硝酸盐测量值与地址登记册相关联，以估计孕前、产前和产后期间的个体平均硝酸盐浓度。优势比 (OR) 和 95% 置信区间 (95%CI) 使用条件逻辑回归控制匹配变量、出生顺序、出生体重、城市化程度、孕产妇教育、就业、收入和吸烟来估计，

结果

没有证据表明硝酸盐与白血病或淋巴瘤有关。在孕前（OR = 1.82，95%CI：1.09 至 3.04）、产前（OR = 1.65，95%CI：0.97 至 2.81）中观察到 CNC 与最高类别的硝酸盐暴露（>25 mg/L 硝酸盐）之间存在关联) 和产后暴露 (OR = 1.48, 95% CI: 0.82 to 2.68) 在完全调整的模型中。在持续硝酸盐暴露和 CNC 模型中也有一些证据表明暴露-反应。

结论

我们的研究结果提供了一些证据，表明暴露于饮用水中的硝酸盐可能会增加儿童患 CNC 癌症的风险，但不会增加白血病或淋巴瘤的风险。