Association of the Colombian armed conflict and poverty with the
incidence and mortality from childhood leukemia in children born during
the years 2002-2013
Abstract
Background: Pediatric acute leukemia is a frequent chronic disease. A
violent environment could cause chronic stress during gestation and
activate oncogenes. Colombia is a country characterized by very high
levels of poverty, and by being struck by a non-international armed
conflict for more than 60 years. Aim: To determine the impact of
perinatal exposure to collective violence and poverty, on the incidence
and mortality rates due to leukemia for Colombian children born during
the years 2002 to 2013. Methods: We apply spatial Poisson-Hurdle models
to model the incidence and mortality rates for leukemia using as
predictors: the Colombian index of armed conflict (IICA), Unmet Basic
Needs (UBN), percentage of health coverage, percentage of people living
in rural areas, and eigenvectors obtained based on Moran eigenvector
spatial filtering. Results: There were 11,149,695 children born in 1122
municipalities of Colombia from 2002 to 2013. There were a total of 4781
cases of childhood leukemia from 2008 to 2016. The risk of suffering
from leukemia or dying from this disease is higher for children exposed
to armed conflict and is lower for children in extreme poverty. All
variables show significant spatial autocorrelation and significant
cross-correlation with the LR and LMR. Conclusion: The Colombian armed
conflict index and poverty variables were significantly statistically
associated with the incidence and mortality rate of Leukemia in
children. Keywords: Leukemia, Colombian armed conflict index, Poverty,
Spatial correlation, Moran index, Poisson-Hurdle models