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American Journal of Epidemiology Advance Access published online on September 28, 2005

American Journal of Epidemiology, doi:10.1093/aje/kwi311
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received February 8, 2005
Accepted June 14, 2005

ORIGINAL CONTRIBUTIONS

Medication Use and Risk of Non-Hodgkin's Lymphoma

Ellen T. Chang 1*, Karin Ekström Smedby 1, Henrik Hjalgrim 2, Claudia Schöllkopf 2, Anna Porwit-MacDonald 3, Christer Sundström 4, Edneia Tani 5, Francesco d'Amore 6, Mads Melbye 2, Hans-Olov Adami 1, and Bengt Glimelius 7

1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
2 Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark
3 Department of Oncology and Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
4 Department of Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
5 Department of Pathology and Cytology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
6 Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
7 Department of Oncology and Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, Radiology and Clinical Immunology, University of Uppsala, Uppsala, Sweden

* To whom correspondence should be addressed.
Ellen T. Chang, E-mail: ellen.chang{at}ki.se


   Abstract

Conflicting results from previous epidemiologic studies shed little light on whether medication use is associated with risk of non-Hodgkin's lymphoma (NHL). To investigate this question, the authors conducted a population-based case-control study in Denmark and Sweden from 1999 to 2002, including 3,055 incident NHL cases and 3,187 controls. Participants reported their past use of medications and history of particular medical conditions. Unconditional logistic regression was used to estimate multivariate odds ratios and 95% confidence intervals for the associations between medication use and risk of NHL; all statistical tests were two sided. Use of antibiotics more than 10 times during adulthood was positively associated with risk of NHL and most major NHL subtypes; when users were compared with nonusers, the odds ratio for NHL was 1.8 (95% confidence interval: 1.4, 2.3); ptrend for total antibiotic use <0.001. In addition, high cumulative use of nonsteroidal anti-inflammatory drugs was marginally associated with elevated NHL risk. Other medications evaluated were not associated with risk of NHL or its most common subtypes. Findings suggest that inflammation, infections, susceptibility to infections, and/or use of antibiotics or nonsteroidal anti-inflammatory drugs to treat these conditions may increase the risk of NHL. However, most of the medications examined were not associated with NHL risk.

Keywords: anti-bacterial agents; anti-inflammatory agents, non-steroidal; case-control studies; drug utilization; lymphoma.
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