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BackgroundImmigrants are sometimes found to have better health than locally born populations. We examined the mortality experience of South Asian origin and white European origin individuals living in Newcastle upon Tyne, UK.MethodsA linked 17–21 year mortality follow-up of a cross-sectional study of European (n=825) and South Asian (n=709) men and women, aged 25–74 years, recruited between 1993 and 1997. Poisson regression was used to estimate mortality rate ratios (MRRs) for all-cause mortality. Sensitivity analysis explored the possible effect of differences between ethnic groups in loss to follow-up. The impact of adjustment for established risk factors on MRRs was studied.ResultsSouth Asians had lower all-cause age-adjusted and sex-adjusted mortality than Europeans (MRR 0.70; 95% CI 0.58 to 0.85). There was higher loss to follow-up in South Asians. Sensitivity analyses demonstrated that this did not account for the observed lower mortality. Adjustment for cardiometabolic, behavioural and socioeconomic characteristics attenuated but did not eliminate the mortality differences between South Asians and Europeans, although CIs now cross 1 (MRR 0.79; 95% CI 0.55 to 1.13).ConclusionsSouth Asians had lower all-cause mortality compared with European origin individuals living in Newcastle upon Tyne that were not accounted for by incomplete mortality data. It is possible that such migrants to the UK have the resources and motivation to move in search of better opportunities and may be healthier and wealthier than those who remain in their country of origin. These findings challenge us to better understand and measure the factors contributing to their survival advantage.

The SHIELD program for Hodgkin lymphoma in patients 60 years of age or older, prospectively evaluated clinical features and outcome in a large patient cohort (n = 175). The central element was a phase 2 study of VEPEMB chemotherapy (n = 103, median age 73 years) incorporating comorbidity assessment. A total of 72 other patients were treated off-study but registered prospectively and treated concurrently with: ABVD (n = 35); CLVPP (n = 19), or other (n = 18). Of VEPEMB patients, 31 had early-stage disease (stage 1A/2A) and received VEPEMB 3 times plus radiotherapy. Median follow-up was 36 months. Complete remission (CR) rate (intention-to-treat) was 74% and 3-year overall survival (OS) and progression-free survival (PFS) were 81% and 74%, respectively. A total of 72 patients had advanced-stage disease (stage 1B/2B/3 or 4) and received VEPEMB 6 times. CR rate was 61% with 3-year OS and PFS of 66% and 58%, respectively. Of patients achieving CR, 13% with early-stage and 5% with advanced-stage disease progressed. Overall treatment-related mortality was 7%. In patients treated with curative intent with VEPEMB, ABVD, and CLVPP (n = 157), CR linked to several factors in univariate analysis. In a Cox regression model only, obtaining CR remained significant for OS and CR plus comorbidity and age for PFS. RS-EBV status had no significant effect on outcome.

There has been speculation that increasing trends in incidence of childhood central nervous system tumors and infant neuroblastoma in the United States have been due to diagnostic improvements or reporting changes. To investigate whether or not such trends could be explained in this way in the U.K., the authors used population-based data from Northwest England to analyze incidence trends in childhood solid tumors. Cases were diagnosed during 1954–1998 and were grouped according to a morphology-based classification scheme. More than 95% of diagnoses were based on special histopathologic review. Tissue sections were retained, and diagnoses were rereviewed to ensure consistency in classification throughout the time period. Age-, gender- and period-specific incidence rates were calculated. Analyses were performed with chi-square tests and Poisson regression. There was an overall increase in the incidence of all childhood solid tumors of 0.9% each year. A temporal increase was found in childhood brain tumors characterized by, in particular, annual increases of 1% in pilocytic astrocytoma, 1% in primitive neuroectodermal tumors, and 2.3% in miscellaneous gliomas. The incidence of germ cell tumors increased at a rate of 2.6% each year. These increases could not be attributed to changes in diagnostic practice, and it is unlikely that the increases were due to changes in reporting practice. Further, the restriction of the increases to certain groups, with stable rates in others, argued against the changes being artifactual. The authors concluded that the increases in incidence were likely to be real. Cancer 2001;92:1967–76. © 2001 American Cancer Society.

This review critically assesses the recent epidemiological evidence for MM in terms of its occurrence and causation. The major feature of the descriptive epidemiology is the excess rates in the US black population. Not a great deal is certain about the causes of MM but there are links with exposures of specific types to ionising irradiation and also farming as an occupation but there is very little evidence to links to cigarette smoking and immune depletion.When the epidemiology of MM is contrasted with other haematogenic malignancies there is clear evidence to suggest MM is unique and not at all similar in this respect to either the lymphomas or the leukaemias.