Epidemiology of chronic lymphocytic leukemia in Sardinia, Italy (1974-2003)

Giorgio Broccia, Jonathan Carter, Cansu Ozsin-Ozler, Sara De Matteis, Pierluigi Cocco

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Several reports have described a worldwide increasing incidence of chronic lymphocytic leukemia (CLL) dating back seven-eight decades. While genetic susceptibility would be an implausible explanation, the determinants of this upward trend and its spatial coordinates are poorly understood. Methods. We explored CLL incidence in Sardinia, Italy, using a validated database including the 1,700 CLL cases diagnosed in 1974-2003. We applied Bayesian methods to map the CLL probability by administrative unit and Poisson regression analysis to investigate socio-economic and environmental determinants adjusting by possible confounders. Results. The standardized (Standard European population) incidence rate for the Sardinian population over the study period was 5.1 per 100,000 (95% Confidence Interval [CI] 4.9 - 5.3), increased annually by 5.8% (95% CI 5.7 - 6.0) consistently by sex and age, and was more noticeable in urban areas. Five administrative units exceeded the 95% posterior probability of an elevated CLL incidence: these were rural areas spread over the regional territory, not suggestive of spatial clustering. The Poisson regression analysis showed that the risk was elevated in urban areas (RR = 1.11, 95% CI 1.05-1.17), among residents ≥ 30 km from the nearest hospital (RR = 1.09, 95% CI 1.06-1.12), and with the local prevalence of cork harvesting (RR = 1.62, 95% CI 1.12-2.34). Conclusions. Our results suggest that better access to healthcare facilities and improvements in diagnostic efficacy might have generated the observed upward trend in CLL incidence, along with contributing environmental factors.
Original languageEnglish
Pages (from-to)37-44
Number of pages8
JournalExperimental Hematology
Early online date9 Aug 2023
Publication statusPublished - 1 Sept 2023

Bibliographical note

Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data are stored on the figshare repository and are publicly available (doi: 10.6084/m9. figshare.23576433).

Publisher Copyright:
© 2023 ISEH – Society for Hematology and Stem Cells


  • chronic lymphocytic leukemia
  • incidence
  • time trends
  • Bayesian methods
  • socio-economic factors


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