1. Epidemiology and Global Health
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Childhood injury after a parental cancer diagnosis

  1. Ruoqing Chen  Is a corresponding author
  2. Amanda Regodón Wallin
  3. Arvid Sjölander
  4. Unnur Valdimarsdóttir
  5. Weimin Ye
  6. Henning Tiemeier
  7. Katja Fall
  8. Catarina Almqvist
  9. Kamila Czene
  10. Fang Fang
  1. Karolinska Institutet, Sweden
  2. University of Iceland, Iceland
  3. Erasmus MC University Medical Center, The Netherlands
  4. Örebro University, Sweden
  5. Karolinska University Hospital, Sweden
Research Article
Cite this article as: eLife 2015;4:e08500 doi: 10.7554/eLife.08500
1 figure, 5 tables, 1 data set and 1 additional file

Figures

Hazard ratios for hospital contacts for injury among children with parental cancer compared to children without parental cancer, according to different characteristics of injury (Hazard ratios were adjusted for attained age, sex, number of siblings, gestational age, mode of delivery and birth weight of the child, paternal age at child's birth, maternal age at child's birth, maternal smoking during early pregnancy, and the highest educational level of the parents).
https://doi.org/10.7554/eLife.08500.006

Tables

Table 1

Characteristics of the participating children and their parents.

https://doi.org/10.7554/eLife.08500.003
All childrenChildren with
parental cancer
Children without
parental cancer
CharacteristicsN (%)N (%)N (%)p
Characteristics of the children
Sex
 Male1,008,982 (51.4)40,527 (51.4)968,455 (51.4)0.72
 Female955,645 (48.6)38,288 (48.6)917,357 (48.6)
No. of siblings and half siblings
 0189,556 (9.6)5,754 (7.3)

183,802 (9.7)

 1784,911 (40.0)28,901 (36.7)756,010 (40.1)<0.001
 2564,343 (28.7)23,291 (29.6)541,052 (28.7)
 ≥ 3425,817 (21.7)20,869 (26.5)404,948 (21.5)
Gestational age (weeks)
 < 3542,376 (2.2)1,833 (2.3)40,543 (2.1)
 35 - 3670,999 (3.6)3,111 (3.9)67,888 (3.6)
 37 - 38363,508 (18.5)15,192 (19.3)348,316 (18.5)
 39 - 40973,949 (49.6)38,169 (48.4)935,780 (49.6)<0.001
 41 - 42456,222 (23.2)18,333 (23.3)437,889 (23.2)
 ≥ 4312,898 (0.7)528 (0.7)12,370 (0.7)
 Missing44,675 (2.3)1,649 (2.1)43,026 (2.3)
Mode of delivery
 Caesarean section237,822 (12.1)10,300 (13.1)227,522 (12.1)
 Vaginal delivery1,684,729 (85.8)66,971 (85.0)1,617,758 (85.8)<0.001
 Missing42,076 (2.1)1,544 (2.0)40,532 (2.1)
Birth weight (g)
 < 250078,412 (4.0)3,455 (4.4)74,957 (4.0)
 2500-2999207,951 (10.6)8,361 (10.6)199,590 (10.6)
 3000-3499604,528 (30.8)23,466 (29.8)581,062 (30.8)
 3500-3999665,343 (33.9)26,714 (33.9)638,629 (33.9)<0.001
 4000-4499290,798 (14.8)12,039 (15.3)278,759 (14.8)
 ≥ 450068,620 (3.5)2,980 (3.8)65,640 (3.5)
 Missing48,975 (2.5)1,800 (2.3)47,175 (2.5)
Maternal smoking in early pregnancy
 No1,421,392 (72.4)55,388 (70.3)

1,366,004 (72.4)

 Yes383,760 (19.5)17,036 (21.6)366,724 (19.5)<0.001
 Missing159,475 (8.1)6,391 (8.1)153,084 (8.1)
Characteristics of the parents
Paternal age at child's birth (years)
 < 2011,942 (0.6)

 166 (0.2)

11,776 (0.6)
 20-24199,251 (10.1)

4,232 (5.4)

195,019 (10.3)
 25-29584,302 (29.7)16,318 (20.7)567,984 (30.1)<0.001
 30-34628,352 (32.0)23,309 (29.6)605,043 (32.1)
 ≥ 35540,780 (27.5)34,790 (44.1)505,990 (26.8)
Maternal age at child's birth (years)
 < 2047,255 (2.4)840 (1.1)46,415 (2.5)
 20-24395,011 (20.1)9,283 (11.8)385,728 (20.5)
 25-29713,827 (36.3)23,318 (29.6)690,509 (36.6)<0.001
 30-34547,990 (27.9)25,787 (32.7)522,203 (27.7)
 ≥ 35260,544 (13.3)19,587 (24.9)240,957 (12.8)
Highest educational level
 Primary school or lower98,230 (5.0)4,144 (5.3)94,086 (5.0)
 Secondary education987,431 (50.3)36,105 (45.8)951,326 (50.5)
 Tertiary education844,523 (43.0)36,812 (46.7)807,711 (42.8)<0.001
 Postgraduate education34,063 (1.7)1,748 (2.2)32,315 (1.7)
 Missing380 (0.0)6 (0.0)374 (0.0)
Table 2

Hazard ratios for hospital contact for injury among children with parental cancer compared to children without parental cancer.

https://doi.org/10.7554/eLife.08500.004
Any Time After Parental Cancer DiagnosisFirst Year After Parental Cancer Diagnosis
CharacteristicsNo. of Children With a Hospital Contact for InjuryPerson-yearsHR (95%CI) *p (Wald Test)No. of Children With a Hospital Contact for InjuryPerson-yearsHR (95%CI) *p (Wald Test)
No parental cancer548,48811,879,0751548,48811,879,0751
Parental cancer15,377298,3021.07 (1.05-1.09)2,67444,6001.27 (1.22-1.33)
 Time since cancer diagnosis
 ≤ 1 year2,67444,6001.27 (1.22-1.33)
 >1 and ≤3 years3,85074,0871.10 (1.07-1.14)<0.001
 > 3 years8,853179,6151.01 (0.99-1.03)
 Sex of the cancer parent
 Male6,554126,2771.08 (1.05-1.11)0.481,16618,9171.32 (1.24-1.40)0.13
 Female8,823172,0261.06 (1.04-1.09)1,50825,6831.24 (1.18-1.31)
 Tobacco-related cancer
 No12,008233,8481.07 (1.05-1.09)0.722,14235,0801.29 (1.24-1.35)0.13
 Yes3,36964,4541.08 (1.04-1.12)5329,5201.20 (1.10-1.31)
 Alcohol-related cancer
 No10,464201,3891.08 (1.05-1.10)0.301,74528,5251.30 (1.24-1.37)0.16
 Yes4,91396,9131.06 (1.02-1.09)92916,0761.23 (1.15-1.31)
 Predicted 5-year relative survival rate
 < 20% §93118,8451.02 (0.95-1.10)1603,0411.15 (0.98-1.35)
 20-80%7,112136,0801.08 (1.06-1.11)0.211,24320,7361.27 (1.19-1.35)0.38
 ≥ 80% 7,334143,3771.06 (1.04-1.09)1,27120,8241.30 (1.23-1.38)
 Parental psychiatric comorbidity after cancer diagnosis
 No14,630285,6211.06 (1.05-1.08)0.0012,61143,6631.27 (1.22-1.32)0.45
 Yes74712,6811.21 (1.12-1.31)639381.41 (1.08-1.85)
  1. HR, hazard ratio; CI, confidence interval

  2. *Adjusted for attained age, sex, number of siblings, gestational age, mode of delivery and birth weight of the child, paternal age at child's birth, maternal age at child's birth, maternal smoking during early pregnancy, and the highest educational level of the parents.

  3. Tobacco-related cancers include cancers in lung, oesophagus, larynx, pharynx, mouth, lip, salivary glands, tongue, stomach, urinary bladder, kidney, uterine cervix, colon and pancreas.

  4. Alcohol-related cancers include cancers in liver, oral cavity, pharynx, larynx, oesophagus, colorectum and breast.

  5. §Including cancers in esophagus, liver, gall bladder, biliary tract, pancreas, lung and stomach.

  6. Including cancers in lip, breast, corpus uteri, testis, skin, thyroid and other endocrine glands, and Hodgkin’s lymphoma.

  7. Including depression, anxiety disorders, stress reaction and adjustment disorder.

Table 3

Hazard ratios for hospital contact for injury among children with parental cancer compared to children without parental cancer, according to sex, age and number of full and half siblings of the child.

https://doi.org/10.7554/eLife.08500.005
No Parental CancerAny Time After Parental Cancer DiagnosisFirst Year After Parental Cancer Diagnosis
Characteristics of the ChildNo. of Children With a Hospital Contact for InjuryPerson-yearsHR (95%CI)No. of Children With a Hospital Contact for InjuryPerson-yearsHR(95%CI)p for interactionNo. of Children With a Hospital Contact for InjuryPerson-yearsHR (95%CI)p for interaction
Sex*
 Male313,8065,966,451

1

9,088150,070
1.11
(1.08-1.13)
< 0.0011,594

22,747

1.30
(1.24-1.37)
0.17
 Female234,6825,912,62416,289148,2331.02
(0.99-1.05)
1,08021,8541.23
(1.16-1.31)
Age (years)
 < 335,157876,76111032,1061.21
(0.99-1.47)
571,1551.25
(0.96-1.63)
 3-555,4521,508,188143911,7751.07
(0.97-1.18)
1313,1811.19
(1.00-1.42)§
 6-11197,9844,625,78614,08588,1061.08
(1.05-1.12)
0.6075614,4351.24
(1.15-1.34)
0.72
 12-15134,9952,500,21614,69883,1991.08
(1.04-1.11)
77711,4291.27
(1.18-1.37)
 ≥ 15124,9002,368,12416,052113,1161.06
(1.03-1.09)
95314,4001.32
(1.23-1.41)
No. of full and half siblings
 056,1741,346,43511,14324,3011.05
(0.98-1.11)
208

3,759

1.30
(1.13-1.50)
 1229,1454,982,31015,806113,7721.06
(1.04-1.09)
0.1398716,9071.24
(1.16-1.32)
0.74
 2151,9853,242,39514,35685,3861.05
(1.02-1.09)
78212,7481.28
(1.19-1.38)
 ≥ 3111,1842,307,93514,072

74,843

1.11
(1.07-1.15)
69711,1871.31
(1.21-1.41)
  1. HR, hazard ratio; CI, confidence interval

  2. *Adjusted for attained age and sex of the child, interaction between sex of the child and cancer of the parents, number of siblings, gestational age, mode of delivery and birth weight of the child, paternal age at child's birth, maternal age at child's birth, maternal smoking during early pregnancy, and the highest educational level of the parents.

  3. Adjusted for attained age of the child, interaction between attained age of the child and cancer of the parents, sex, number of siblings, gestational age, mode of delivery and birth weight of the child, paternal age at child's birth, maternal age at child's birth, maternal smoking during early pregnancy, and the highest educational level of the parents.

  4. Adjusted for attained age, sex and number of siblings of the child, interaction between number of siblings of the child and cancer of the parents, gestational age, mode of delivery and birth weight of the child, paternal age at child's birth, maternal age at child's birth, maternal smoking during early pregnancy, and the highest educational level of the parents

  5. §p = 0.054

Table 4

Hazard ratios for hospital contact for injury among children with parental cancer compared to children without parental cancer, according to the number of previous hospital contact for injury of the child

https://doi.org/10.7554/eLife.08500.007
CharacteristicsNo. of Children With a Hospital Contact for InjuryPerson-yearsHR (95%CI) *
No contact
 No parental cancer548,48811,879,0751
 Parental cancer15,377298,3021.07 (1.05-1.09)
One contact
 No parental cancer228,5601,542,9261
 Parental cancer5,98131,3081.24 (1.20-1.28)
Two contacts
 No parental cancer107,833454,0491
 Parental cancer2,7969,1301.26 (1.20-1.32)
Three contacts
 No parental cancer53,784176,2371
 Parental cancer1,3773,6911.21 (1.13-1.31)
Four contacts
 No parental cancer28,12674,4991
 Parental cancer7221,6001.19 (1.07-1.33)
  1. HR, hazard ratio; CI, confidence interval

  2. *Adjusted for attained age, sex, number of siblings, gestational age, mode of delivery and birth weight of the child, paternal age at child's birth, maternal age at child's birth, maternal smoking during early pregnancy, and the highest educational level of the parents

Table 5

Swedish revisions of the international classification of diseases (ICD) for psychiatric comorbidity of the cancer parents.

https://doi.org/10.7554/eLife.08500.008
ICD 8 (1969-1986)ICD 9 (1987-1996)ICD-10 (1997-presesnt)
Depression296.2, 298.0, 300.4296B, 300E, 311F32-F39
Anxiety disorders300 except 300.3, 300.4300 except 300D, 300EF40, F41, F44, F45, F48
Stress reaction and adjustment disorder307308, 309F43

Data availability

The following data sets were generated
  1. 1
    Swedish national registers
    1. Almqvist C
    2. Ye W
    3. Czene K
    (2015)
    The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. The data used in this study are owned by the Swedish National Board of Health and Welfare and Statistics Sweden. According to Swedish law, the authors are not able to make the dataset publicly available. Any researchers (including international researchers) interested in obtaining the data can do so by the following steps: 1) apply for ethical approval from their local ethical review boards; 2) contact the Swedish National Board of Health and Welfare and/or Statistics Sweden with the ethical approval and make a formal application of use of register data. Contact emails for request of register data: Swedish National Board of Health and Welfare: registerservice@socialstyrelsen.se, Statistics Sweden: Mikrodata.individ@scb.se. Please visit http://www.socialstyrelsen.se/register/bestalladatastatistik/bestallaindividuppgifterforforskningsandamal (the Swedish National Board of Health and Welfare) and http://www.scb.se/sv_/Vara-tjanster/bestalla-mikrodata/ (the Statistics Sweden) for detailed information about how to apply for access to register data for research purposes.

Additional files

Reporting standards

Standard used to collect data: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies

https://doi.org/10.7554/eLife.08500.009

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