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Wolfgang Hoffmann,¹ Claudia Terschueren,¹ and David B. Richardson²

¹Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany; ²Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA

Abstract
Background: During 1990–1991 a childhood leukemia cluster was observed in the sparsely populated region surrounding two nuclear establishments southeast of Hamburg, Germany. Since then, several new cases have been reported. Recently a possible accidental release of radionuclides in 1986 was hypothesized.

Objective: The objective of this study was to analyze the childhood leukemia incidence in this area since 1990.

Methods: All incident cases (< 15 years of age) were ascertained during 1990–2005 within a 5-km radius of the Krümmel nuclear power plant. We derived standardized incidence ratios (SIRs) using county and national leukemia incidence rates as referents. We stratified analyses by calendar period and attained age, and by subdividing the study region into areas north versus south of the Elbe river.

Results: Fourteen cases were ascertained in the study area, whereas 4.0 were expected based on national referent rates [1990–2005: SIR = 3.5 ; 95% confidence interval (CI) , 1.9–5.9]. The excess was not confined to the early 1990s ; for the more recent time period 1999–2005, the SIR is still elevated (SIR = 2.7 ; 95% CI, 0.9–6.2) . SIRs of greatest magnitude were observed for children 0–4 years of age (SIR = 4.9 ; 95% CI, 2.4–9.0) and for residents south of the Elbe (SIR = 7.5 ; 95% CI, 2.8–16.4) .

Conclusions: The incidence in this region is significantly higher than the childhood leukemia incidence for Germany as a whole. To date, no unique hazards have been identified in this population. The fact that the elevated rates have persisted in this community for > 15 years warrants further investigation.

Key words: childhood leukemia, Germany, nuclear installations, standardized incidence ratio, time windows, vicinity. Environ Health Perspect 115:947–952 (2007) . doi:10.1289/ehp.9861 available via http://dx.doi.org/ [Online 15 March 2007]

Address correspondence to W. Hoffmann, Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt University of Greifswald, Ellernholzstrasse 1-2, D-17489 Greifswald, Germany. Telephone: (+49) 3834 867751. Fax: (+49) 3834 867752. E-mail: wolfgang.hoffmann@uni-greifswald.de

Supplemental Material is available online at http://www.ehponline.org/docs/2007/9861/suppl.pdf

We thank M. Csicsaky and G. Raguse-Degener (Ministry for Social Affairs, Women, Family and Health of Lower Saxony, Germany) and H. Dieckmann, representative of the citizen's group against leukemia in the Elbmarsch ("Bürgerinitiative gegen Leukämie in der Elbmarsch") , Reppenstedt, Germany, for provision of valuable information on the incident cases. We are also grateful to the treating physicians in the Elbmarsch area for participating in the incidence study. We thank the parents and relatives of many of the children who were diagnosed with leukemia in the study region, for their cooperation and support.

W.H. and C.T. are funded by the NBL-3-Programm of the German Federal Ministry of Education and Research (BMB+F NBL-3, Phase 2, No. 01ZZ0403) . D.R. was funded by the Alfried-Krupp-von Bohlen und Halbach Foundation, Fellowship Programm "Life Sciences–Medizin, Lebens- und Gesundheitswissenschaften" (1 May 2006–15 August 2006, at the Alfried-Krupp-Kolleg, Greifswald, Germany)

The authors declare they have no competing financial interests.

Received 27 October 2006 ; accepted 15 March 2007.