{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T13:17:48Z","timestamp":1758892668059,"version":"3.37.3"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014584","name":"Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Epidemiol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Increased incidence rates for childhood leukaemia have been reported in municipalities close to the nuclear power plant (NPP) Kr\u00fcmmel (Geesthacht, Germany). Methodological challenges arise when analysing this association at ecological level. They include the use of an appropriate reference population, unstable estimates of standardised incidence ratios (SIRs), and the potential role of prevailing winds. The aim of our study is to address these challenges. The German Childhood Cancer Registry provided data on leukaemia in children under 15\u00a0years (2004\u20132019). The German Federal Statistical Office provided the population data. The study region included all municipalities with\u2009\u2265\u200975% surface area within 50\u00a0kms from the Kr\u00fcmmel NPP. We calculated SIRs using national and regional reference rates. Smoothed incidence relative rates (IRRs) were calculated and mapped to check for potential patterns associated with prevailing winds. Overall 356 cases of childhood leukaemia were observed in the study region (321 municipalities) during 2004\u20132019. SIRs based on national reference rates show nearly no difference to those calculated using the regional rates as reference. Increased SIR and IRR were observed in Geesthacht (observed-cases\u2009=\u2009eight; SIR\u2009=\u20092.29; 95% confidence interval: 0.99\u20134.51. IRR\u2009=\u20091.80; 95% credibility interval: 0.88\u20132.79). The analysis of the IRR map does not show patterns associated with prevailing winds. Using a regional population as the reference, we found evidence that there may still be an increased risk for childhood leukaemia in Geesthacht. However, IRR estimates are uncertain and credibility intervals are compatible with the absence of elevated risk. The persistent evidence of risk of childhood leukaemia in Geesthacht warrants further epidemiological surveillance.<\/jats:p>","DOI":"10.1007\/s10654-024-01182-w","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T03:09:29Z","timestamp":1732590569000},"page":"1373-1378","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A municipality-specific analysis to investigate persistent increased incidence rates of childhood leukaemia near the nuclear power plant of Kr\u00fcmmel in Germany"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3473-0752","authenticated-orcid":false,"given":"Emilio","family":"Gianicolo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonello","family":"Russo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rossana","family":"Di Staso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9cile M.","family":"Ronckers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Schmidtmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Wollschl\u00e4ger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Blettner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"key":"1182_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1289\/ehp.94-1567974","volume":"94","author":"MJ Gardner","year":"1991","unstructured":"Gardner MJ. Father\u2019s occupational exposure to radiation and the raised level of childhood leukemia near the Sellafield nuclear plant. Environ Health Perspect. 1991;94:5\u20137. https:\/\/doi.org\/10.1289\/ehp.94-1567974.","journal-title":"Environ Health Perspect"},{"key":"1182_CR2","unstructured":"COMARE. 1st, 2nd, 3rd, 14th Report. United Kingdom 1986, 1988, 1989."},{"key":"1182_CR3","unstructured":"Black D. Investigation of the possible increased incidence of cancer in West Cumbria. Report of the Independent Advisory Group. HMSO London 1984."},{"issue":"4","key":"1182_CR4","doi-asserted-by":"publisher","first-page":"R43","DOI":"10.1088\/1361-6498\/aa8ce9","volume":"37","author":"B Grosche","year":"2017","unstructured":"Grosche B, Kaatsch P, Heinzow B, Wichmann HE. The Krummel (Germany) Childhood Leukaemia Cluster: a review and update. J Radiol Prot. 2017;37(4):R43\u201358. https:\/\/doi.org\/10.1088\/1361-6498\/aa8ce9.","journal-title":"J Radiol Prot"},{"issue":"8885","key":"1182_CR5","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1016\/0140-6736(93)92959-W","volume":"342","author":"I Schmitz-Feuerhake","year":"1993","unstructured":"Schmitz-Feuerhake I, Schroder H, Dannheim B, et al. Leukaemia near water nuclear reactor. The Lancet. 1993;342(8885):1484. https:\/\/doi.org\/10.1016\/0140-6736(93)92959-W.","journal-title":"The Lancet"},{"key":"1182_CR6","unstructured":"Bundesministerium f\u00fcr Umwelt Naturschutz nukleare Sicherheit und Verbraucherschutz (BMUV). Sicherheit in der Kerntechnik. Ein Informationsportal von Bund und L\u00e4ndern. 2024. https:\/\/www.nuklearesicherheit.de\/kerntechnische-anlagen\/. Accessed 21.08.2024."},{"issue":"6","key":"1182_CR7","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1289\/ehp.9861","volume":"115","author":"W Hoffmann","year":"2007","unstructured":"Hoffmann W, Terschueren C, Richardson DB. Childhood leukemia in the vicinity of the Geesthacht nuclear establishments near Hamburg. Germany Environ Health Perspect. 2007;115(6):947\u201352. https:\/\/doi.org\/10.1289\/ehp.9861.","journal-title":"Germany Environ Health Perspect."},{"issue":"5","key":"1182_CR8","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1002\/ijc.34303","volume":"152","author":"A Russo","year":"2023","unstructured":"Russo A, Blettner M, Merzenich H, Wollschlaeger D, Erdmann F, Gianicolo E. Incidence of childhood leukemia before and after shut down of nuclear power plants in Germany in 2011: a population-based register study during 2004\u20132019. Int J Cancer. 2023;152(5):913\u201320. https:\/\/doi.org\/10.1002\/ijc.34303.","journal-title":"Int J Cancer"},{"issue":"40","key":"1182_CR9","doi-asserted-by":"publisher","first-page":"679","DOI":"10.3238\/arztebl.m2023.0171","volume":"120","author":"A Russo","year":"2023","unstructured":"Russo A, Terracini B, Blettner M, Gianicolo E. The incidence of Leukemia in children living near nuclear power plants in Germany (2004\u20132019). Dtsch Arztebl Int. 2023;120(40):679\u201380. https:\/\/doi.org\/10.3238\/arztebl.m2023.0171.","journal-title":"Dtsch Arztebl Int"},{"key":"1182_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.spasta.2022.100593","volume":"50","author":"YC MacNab","year":"2022","unstructured":"MacNab YC. Bayesian disease mapping: past, present, and future. Spatial Statist. 2022;50: 100593. https:\/\/doi.org\/10.1016\/j.spasta.2022.100593.","journal-title":"Spatial Statist."},{"key":"1182_CR11","unstructured":"B\u00f6ckig A, Siller V. Vorherrschende Windrichtung und Studienregion. Deutsches Arzteblatt International. IN PRESS."},{"key":"1182_CR12","doi-asserted-by":"crossref","unstructured":"Banerjee S, Carlin BP, Gelfand AE. Hierarchical Modeling and Analysis for Spatial Data 2nd Edition 2015.","DOI":"10.1201\/b17115"},{"key":"1182_CR13","doi-asserted-by":"crossref","unstructured":"Lawson AB. Using R for Bayesian Spatial and Spatio-Temporal Health Modeling Hall C, editor: CRC Press Taylor & Francis Group. A Chapman and Hall book; 2021.","DOI":"10.1201\/9781003043997"},{"key":"1182_CR14","unstructured":"Ramachandran KM, Tsokos CP. Chapter 13\u2014empirical methods. Mathematical statistics with applications: Elsevier Academic Press; 2009."},{"key":"1182_CR15","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/1476-072x-8-55","volume":"8","author":"MC Jackson","year":"2009","unstructured":"Jackson MC, Huang L, Luo J, Hachey M, Feuer E. Comparison of tests for spatial heterogeneity on data with global clustering patterns and outliers. Int J Health Geogr. 2009;8:55. https:\/\/doi.org\/10.1186\/1476-072x-8-55.","journal-title":"Int J Health Geogr"},{"issue":"2","key":"1182_CR16","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/s10109-005-0156-5","volume":"7","author":"V G\u00f3mez-Rubio","year":"2005","unstructured":"G\u00f3mez-Rubio V, Ferr\u00e1ndiz-Ferragud J, L\u00f3pez-Qu\u00edlez A. Detecting clusters of disease with R. J Geogr Syst. 2005;7(2):189\u2013206. https:\/\/doi.org\/10.1007\/s10109-005-0156-5.","journal-title":"J Geogr Syst"},{"issue":"21\u201322","key":"1182_CR17","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1002\/sim.4780142105","volume":"14","author":"T Tango","year":"1995","unstructured":"Tango T. A class of tests for detecting \u2018general\u2019 and \u2018focused\u2019 clustering of rare diseases. Stat Med. 1995;14(21\u201322):2323\u201334. https:\/\/doi.org\/10.1002\/sim.4780142105.","journal-title":"Stat Med"},{"key":"1182_CR18","first-page":"395","volume-title":"Diseases mapping and risk assessment for public health","author":"W Hoffmann","year":"1999","unstructured":"Hoffmann W, Schlattmann P. An analysis of the geographical distribution of Leukaemia incidence in the Vicinity of a suspected point source: a case study. In: Lawson A, Biggeri A, B\u00f6hning D, Lesaffre E, Viel J-F, Bertollini R, editors. Diseases mapping and risk assessment for public health. Chicheste: Wiley; 1999. p. 395\u2013409."}],"container-title":["European Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10654-024-01182-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10654-024-01182-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10654-024-01182-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T06:08:27Z","timestamp":1735279707000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10654-024-01182-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,26]]},"references-count":18,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["1182"],"URL":"https:\/\/doi.org\/10.1007\/s10654-024-01182-w","relation":{},"ISSN":["0393-2990","1573-7284"],"issn-type":[{"type":"print","value":"0393-2990"},{"type":"electronic","value":"1573-7284"}],"subject":[],"published":{"date-parts":[[2024,11,26]]},"assertion":[{"value":"28 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}