Background

An association between Coxiella burnetii and non-Hodgkin lymphoma has been suggested. After a large Q fever epidemic in the Netherlands (2007–10), we postulated that the incidence of non-Hodgkin lymphoma would be increased during and after the epidemic in areas with a high endemicity of Q fever compared with those with low endemicity.

Methods

We did a retrospective population-based analysis and calculated relative risks (RRs) of non-Hodgkin lymphoma during 1-year periods before, during, and after the Q fever epidemic, for areas with intermediate and high endemicity of Q fever compared with low endemic areas. We also calculated the RR of non-Hodgkin lymphoma in people with chronic Q fever compared with the general population.

Findings

Between Jan 1, 2002, and Dec 31, 2013, 48 760 cases of non-Hodgkin lymphoma were diagnosed. The incidence of non-Hodgkin lymphoma ranged from 21·4 per 100 000 per year in 2002 to 26·7 per 100 000 per year in 2010. A significant association with non-Hodgkin lymphoma was noted in 2009 for areas with a high endemicity of Q fever compared with low endemic areas (RR 1·16, 95% CI 1·02–1·33; p=0·029); no further associations were noted in any other year or for areas with intermediate Q fever endemicity. Among 439 individuals with chronic Q fever, five developed non-Hodgkin lymphoma, yielding a crude absolute risk of 301·0 cases per 100 000 per year (RR 4·99, 95% CI 2·07–11·98; p=0·0003) compared with the general population in the Netherlands.

Interpretation

These findings do not support the hypothesis that Q fever has a relevant causal role in the development of non-Hodgkin lymphoma. Several limitations, inherent to the design of this study, might lead to both underestimation and overestimation of the studied association.

Funding

Foundation Q-support and Institut Mérieux.

中文翻译：

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暴露于贝氏柯克斯体和非霍奇金淋巴瘤的风险：荷兰一项回顾性人群为基础的分析

背景

之间的关联贝氏柯克斯体和非霍奇金淋巴瘤已建议。在荷兰发生Q病大流行之后（2007-10年），我们假设在Q病高发地区与低流行地区相比，非霍奇金淋巴瘤的发病率会在流行期间和之后增加。

方法

我们进行了一项基于人群的回顾性分析，并计算了Q发热流行中，高流行地区与低流行地区相比在Q发热流行之前，期间和之后的1年内非霍奇金淋巴瘤的相对风险（RRs）地区。我们还计算了与一般人群相比慢性Q型发热患者非霍奇金淋巴瘤的RR。

发现

在2002年1月1日至2013年12月31日期间，共诊断出48 760例非霍奇金淋巴瘤病例。非霍奇金淋巴瘤的发病率从2002年的每年每10万的21·4到2010年的每年每10万的26·7的范围。2009年，非霍奇金淋巴瘤的高流行地区被认为与非霍奇金淋巴瘤有显着相关性。 Q发热与低流行地区相比（RR 1·16，95％CI 1·02-1·33； p = 0·029）；在其他任何年份或中度Q发热流行地区，均未发现进一步的关联。在439例慢性Q发热患者中，有5例发展为非霍奇金淋巴瘤，每年每10万的绝对绝对风险为301·0例（RR 4·99，95％CI 2·07-11·98； p = 0 （0003）与荷兰的总人口相比。

解释

这些发现不支持以下假设，即Q发热在非霍奇金淋巴瘤的发生中具有相关的因果作用。本研究设计固有的一些局限性可能导致对所研究协会的低估和高估。

资金

基金会Q支持和梅里埃研究所。