Hodgkin's Disease in Childhood: An Epidemiologic Study

Study was made of 359 death certificates of United States children who died of Hodgkin's disease, 1960–64, and of 314 hospital charts of children with this neoplasm. Unlike most childhood neoplasms, there was no early peak in mortality or relation to specific congenital defects to suggest a prenatal origin. Hodgkin's disease in children increased progressively with age, and the much earlier rise in morbidity among boys resulted in a 3:1 male excess. The sex ratio diminished from 10–12 years of age, indicating that the transition to the pattern of Hodgkin's disease in young adults may occur at this time. Among boys dying of Hodgkin's disease, a higher than expected number were born in July and August, suggesting the role early in life of sex-limited environmental agents with seasonal prevalence. Excessive mortality also occurred in the West-South Central division of the United States, an area with the lowest rate for the disease at older ages. Among children there was no difference in mortality by race, in contrast to the excess among white adults. A number of features of Hodgkin's disease in children and in young adults are consistent with the activity of environmental factors, with certain childhood patterns resulting possibly from exposure or enhanced susceptibility to such factors close to birth.