Date of Award

January 2020

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Xiaomei Ma


The etiology of non-Hodgkin lymphoma (NHL) in pediatric, adolescent, and young adult patients is not well-understood. We evaluated potential associations between birth characteristics and NHL risk in the California Linkage Study of Early-onset Cancers, a population-based case-control study. This study included 3,064 cases of NHL diagnosed at the age of 0-37 years in California during 1988-2015 and 153,200 controls frequency matched on year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from an unconditional multivariable logistic regression model built using step-wise selection procedures. After adjusting for sex, race/ethnicity, plurality, birth weight, age of the mother at the time of delivery, and maternal education, individuals born via cesarean section had a decreased risk of early-onset NHL compared to individuals born vaginally (OR=0.88; 95% CI: 0.81, 0.97). Additionally, individuals with a birth order of 3 or higher had a decreased risk of early-onset NHL compared to first-borns (OR=0.87; 95% CI: 0.79, 0.96). Subgroup analyses by age of diagnosis (0-14 vs 15-37 years), histology subtype, and race/ethnicity revealed some heterogeneity across different strata. These findings suggest that factors associated with the development and early stimulation of the immune system may play a role in the etiology of early-onset NHL.


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