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Open Access Open Badges Research article

The association between Acute Lymphoblastic Leukemia in children and Helicobacter pylori as the marker for sanitation

Pengiran Hishamuddin

Author Affiliations

Surveillance and Response Branch, Communicable Diseases Division, Ministry of Health, 16 College Road, Singapore, 169854, Republic of Singapore

BMC Research Notes 2012, 5:345  doi:10.1186/1756-0500-5-345

Published: 3 July 2012



Greaves “delayed infection” hypothesis suggested that Acute Lymphoblastic Leukemia (ALL) in children is caused by a lack of exposure to infection in infancy, which may be due higher standards of sanitation. We have conducted an ecologic analysis of the relationship between sanitation, using Helicobacter pylori (H. pylori) as the marker, and the incidence of childhood ALL in 127 cancer registries from 28 countries.


There were inverse associations between H. pylori prevalence and ALL incidence rates in children. These associations were minor and only significant for ALL incidence rates for all cancer registries. They became non-significant and smaller in magnitude when the population source and/or the GNP per capita were added to the relationship. Furthermore, these results were unchanged when the associations were examined using the Generalized Estimating Equations.


Although the findings showed lower prevalence of H. pylori and improved sanitation is associated with increased incidence of childhood ALL, they do not conclusively support Greaves “delayed infection” hypothesis.

Public health; Epidemiology; Oncology