{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T06:53:16Z","timestamp":1791096796980,"version":"4.1.0"},"reference-count":44,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":91,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,9,11]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Increases in thyroid cancer have been reported as one of the major public health consequences of the Chornobyl accident. Using an excess relative risk (ERR) model and detailed district-level data across Ukraine, we aimed to estimate the association between iodine-131 exposure and thyroid cancer risk while accounting for spatial confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This ecological study used data on all diagnosed thyroid cancer cases in 2001 among individuals aged 15 years or older and settlement-level iodine-131 thyroid doses from 1986, covering the entire territory of Ukraine and encompassing 627 spatial units (districts and cities). District doses were estimated by sex and age using areal-weighted interpolation. District-level standardised incidence ratios (SIRs) were calculated and smoothed with negative binomial regression and spatial P-splines. The ERR was assessed using an intrinsic conditional autoregressive negative binomial (ICAR-NB) model adjusting for sex, age at exposure and district-specific effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Excess thyroid cancer incidence was observed not only in northern districts near the Chornobyl plant but also in several central districts. The ICAR-NB model produced lower ERR estimates than the corresponding model without district-level adjustment, suggesting that risks may be overestimated when spatial dependencies are ignored (ages at exposure 0\u20134: 24.85 (95% CI 7.78 to 41.78)\u2009vs 48.09 (95% CI 17.05 to 79.11)). ERRs were significant for both sexes although sex differences were not statistically significant. Risk decreased strongly with age at exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study underscores the value of small-area data analysis and spatial modelling for assessing radiation-related health risks and offers methodological guidance for future studies following nuclear accidents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004376","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T06:26:41Z","timestamp":1791095201000},"page":"e004376","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Tracing echoes from the past: a district-level analysis of thyroid cancer incidence and radiation exposure in post-Chornobyl Ukraine"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4944-684X","authenticated-orcid":false,"given":"Nataliia","family":"Levchuk","sequence":"first","affiliation":[{"name":"Laboratory of Population Health, Max-Planck-Institute for Demographic Research, Rostock, Germany"},{"name":"Demographic Modeling and Projection Department, Mykhailo Ptukha Institute for Demography and Life Quality Research, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3340-8518","authenticated-orcid":false,"given":"Jonas","family":"Sch\u00f6ley","sequence":"additional","affiliation":[{"name":"Laboratory of Population Health, Max-Planck-Institute for Demographic Research, Rostock, Germany"},{"name":"Max Planck - University of Helsinki Center for Social Inequalities in Population Health (MaxHel Center), Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0096-6337","authenticated-orcid":false,"given":"Laura","family":"Cilek","sequence":"additional","affiliation":[{"name":"Research Area of Ageing, Mortality and Population Dynamics, Federal Institute for Population Research, Wiesbaden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9959-9292","authenticated-orcid":false,"given":"Domantas","family":"Jasilionis","sequence":"additional","affiliation":[{"name":"Max Planck - University of Helsinki Center for Social Inequalities in Population Health (MaxHel Center), Rostock, Germany"},{"name":"Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany"},{"name":"Vytautas Kavolis Transdisciplinary Research Institute, Vytautas Magnus University, Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093004101243000_4.3.e004376.1","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxi012"},{"key":"2026093004101243000_4.3.e004376.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2011.01.510"},{"key":"2026093004101243000_4.3.e004376.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvrad.2016.02.003)"},{"key":"2026093004101243000_4.3.e004376.4","unstructured":"UNSCEAR, United Nations Scientific Committee on the Effects of Atomic Radiation . Evaluation of data on thyroid cancer in regions affected by the Chernobyl accident. A white paper to guide the Scientific Committee\u2019s future programme of work. New-York; 2018."},{"key":"2026093004101243000_4.3.e004376.5","unstructured":"Basyka DA , ed. Thirty-five years of the Chernobyl disaster: radiological and medical consequences, protection strategies, and revival: national report of Ukraine. Kyiv; 2021."},{"key":"2026093004101243000_4.3.e004376.6","unstructured":"UNSCEAR . Sources and effects of ionizing radiation: UNSCEAR 2008 report to the General Assembly with scientific annexes. Vol. II: Scientific Annexes C, D, and E. United Nations; 2011. Available: https:\/\/www.unscear.org\/unscear\/en\/publications\/2008_2.html"},{"key":"2026093004101243000_4.3.e004376.7","unstructured":"UNSCEAR . Sources, effects and risks of ionizing radiation: UNSCEAR 2020\/2021 report to the General Assembly with scientific annexes: Volume II: Scientific Annex B. United Nations; 2022. Available: https:\/\/www.unscear.org\/unscear\/en\/publications\/2020_2021_2.html"},{"key":"2026093004101243000_4.3.e004376.8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s10654-022-00862-9","article-title":"War in Europe: health implications of environmental nuclear disaster amidst war","volume":"37","author":"Laine","year":"2022","journal-title":"Eur J Epidemiol"},{"key":"2026093004101243000_4.3.e004376.9","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.959668","article-title":"Health effects of radioactive contaminated dust in the aftermath of potential nuclear accident in Ukraine","volume":"10","author":"Sharifi","year":"2022","journal-title":"Front Public Health"},{"key":"2026093004101243000_4.3.e004376.10","unstructured":"Plokhy S . Chernobyl Roulette: war in the nuclear disaster zone. W. W. Norton & Company, 2024."},{"key":"2026093004101243000_4.3.e004376.11","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2020.569041","article-title":"Radiation Exposure to the Thyroid After the Chernobyl Accident","volume":"11","author":"Drozdovitch","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026093004101243000_4.3.e004376.12","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.30857"},{"key":"2026093004101243000_4.3.e004376.13","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605967"},{"key":"2026093004101243000_4.3.e004376.14","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6690545"},{"key":"2026093004101243000_4.3.e004376.15","doi-asserted-by":"publisher","DOI":"10.1667\/RR3233"},{"key":"2026093004101243000_4.3.e004376.16","doi-asserted-by":"publisher","DOI":"10.1667\/RR3593.1"},{"key":"2026093004101243000_4.3.e004376.17","doi-asserted-by":"publisher","DOI":"10.1667\/RR3479.1"},{"key":"2026093004101243000_4.3.e004376.18","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djj244"},{"key":"2026093004101243000_4.3.e004376.19","unstructured":"Tronko M , Bogdanova T , Saenko V , et al , eds. Thyroid cancer in Ukraine after Chernobyl. Dosimetry, epidemiology, pathology, molecular biology. Nagasaki: Nagasaki Association for Hibakushas\u2019 Medical Care (NASHIM), 2014."},{"key":"2026093004101243000_4.3.e004376.20","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1002674"},{"key":"2026093004101243000_4.3.e004376.21","doi-asserted-by":"crossref","first-page":"106230","DOI":"10.1016\/j.envint.2020.106230","article-title":"Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident","volume":"146","author":"Cl\u00e9ro","year":"2021","journal-title":"Environ Int"},{"key":"2026093004101243000_4.3.e004376.22","unstructured":"IARC Expert Group on Thyroid Health Monitoring after Nuclear Accidents . Thyroid health monitoring after nuclear accidents (IARC technical publication no.46). Lyon, France: International Agency for Research on Cancer, 2018."},{"key":"2026093004101243000_4.3.e004376.23","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/S1470-2045(18)30680-6","article-title":"Long-term strategies for thyroid health monitoring after nuclear accidents: recommendations from an Expert Group convened by IARC","volume":"19","author":"Togawa","year":"2018","journal-title":"Lancet Oncol"},{"key":"2026093004101243000_4.3.e004376.24","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.canep.2018.02.002","article-title":"Evaluation of data quality at the National Cancer Registry of Ukraine","volume":"53","author":"Ryzhov","year":"2018","journal-title":"Cancer Epidemiol"},{"key":"2026093004101243000_4.3.e004376.25","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s00411-021-00930-w","article-title":"Thyroid doses in Ukraine due to 131I intake after the Chornobyl accident. Report II: dose estimates for the Ukrainian population","volume":"60","author":"Masiuk","year":"2021","journal-title":"Radiat Environ Biophys"},{"key":"2026093004101243000_4.3.e004376.26","unstructured":"MAPA, Digital Atlas of Ukraine, Chernobyl\/Chornobyl Project, Harvard Ukrainian Research Institute . MAPA digital atlas of ukraine. 2026. Available: https:\/\/www.gis.huri.harvard.edu\/chornobyl"},{"key":"2026093004101243000_4.3.e004376.27","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1559\/152304083783914958","article-title":"Spatial interpolation methods: a review","volume":"10","author":"Lam","year":"1983","journal-title":"Am Cartographer"},{"key":"2026093004101243000_4.3.e004376.28","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/37.1-2.17"},{"key":"2026093004101243000_4.3.e004376.29","doi-asserted-by":"publisher","DOI":"10.1191\/0962280205sm388oa"},{"key":"2026093004101243000_4.3.e004376.30","doi-asserted-by":"crossref","unstructured":"Wood S . Generalized additive models: an introduction with R. 2nd edn. Chapman and Hall\/CRC, 2017.","DOI":"10.1201\/9781315370279"},{"key":"2026093004101243000_4.3.e004376.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-4632.1995.tb00338.x"},{"key":"2026093004101243000_4.3.e004376.32","doi-asserted-by":"publisher","DOI":"10.1111\/2041-210X.13168"},{"key":"2026093004101243000_4.3.e004376.33","doi-asserted-by":"publisher","DOI":"10.1667\/3148"},{"key":"2026093004101243000_4.3.e004376.34","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dji129"},{"key":"2026093004101243000_4.3.e004376.35","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"2026093004101243000_4.3.e004376.36","doi-asserted-by":"crossref","first-page":"31","DOI":"10.15407\/dse2011.02.031","article-title":"The lessons from Chernobyl: an ecological migration","volume":"2","author":"Gunko","year":"2011","journal-title":"Demogr Soc Ekon"},{"key":"2026093004101243000_4.3.e004376.37","unstructured":"Gunko N. V . Socio-geographic problems of population evacuation in Ukraine from the radiation disaster zone [Extended abstract of thesis]. Institute of Geography of the National Academy of Sciences of Ukraine, Kyiv, 1996"},{"key":"2026093004101243000_4.3.e004376.38","first-page":"60","article-title":"The demographic situation in the radiation-contaminated areas of Ukraine and ways to improve it","volume":"22","author":"Glukhanova","year":"2000","journal-title":"Demohrafichni Doslidzhennia"},{"key":"2026093004101243000_4.3.e004376.39","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2005.15.1291"},{"key":"2026093004101243000_4.3.e004376.40","first-page":"355","article-title":"Iodine status and thyroid radiation doses in people affected by the Chornobyl disaster living in the northern regions of Ukraine (Ukrainian-American cohort study)","volume":"19","author":"Tronko","year":"2013","journal-title":"Zhurnal Natsionalnoi Akademii Medychnykh Nauk Ukrainy"},{"key":"2026093004101243000_4.3.e004376.41","unstructured":"Matasar IT , Kravchenko VI , Vodopianov VM , et al . Iodine deficiency in the human body as a social, medical, and environmental problem. Shchek; 2020."},{"key":"2026093004101243000_4.3.e004376.42","first-page":"82","article-title":"Epidemiology and clinical-morphological features of thyroid cancer in persons living in the Vinnytsia region","volume":"7","author":"Palamarchuk","year":"2016","journal-title":"Mizhnarodnyi Endokrynolohichnyi Zhurnal"},{"key":"2026093004101243000_4.3.e004376.43","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyg205"},{"key":"2026093004101243000_4.3.e004376.44","unstructured":"Gladun OM , ed. Electronic registers: the state of play in Ukraine. Ptukha Institute for Demography and Social Studies of the National Academy of Sciences of Ukraine; 2021.636. Available: https:\/\/idss.org.ua\/arhiv\/registers3.pdf"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T06:26:45Z","timestamp":1791095205000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9,30]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2025-004376"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004376","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}