Epidemiological studies rely on the uneven distribution of disease within and between populations and represent a simple but efficient way of studying disease causation. The incidence of non-Hodgkin’s lymphomas (NHLs) has increased dramatically over the past few decades and the epidemic calls for epidemiological studies. The study of Munksgaard and colleagues, in this issue of Dermatology, is a good example of an epidemiological study based on the so-called ecological correlation. It focuses on cutaneous B-cell lymphoma (CBCL) and fails to document a correlation between CBCL incidence and Lyme disease as a surrogate indicator for the exposure to tick bites. Although ecological studies neither inform about the time relationship between exposure and disease nor usually allow control for confounding variables, they can provide important information that would guide the direction of further research. There is a number of analytical studies focusing on risk factors for NHLs. One drawback of these studies is that they consider NHLs as a single category. One merit of the paper of Munksgaard et al. is that it focused on a rather specific disease, i.e. CBCL.

1.
Hippocrates. Airs, waters, places; in Buck C, Llopis A, Najera E, Terris M (eds): The Challenge of Epidemiology: Issues and Selected Readings, Sci Publ No 505. Washington, Pan American Health Organization, 1988, pp 18–19.
2.
Harris ED: Lyme disease: Success for academia and the community. N Engl J Med 1984;308:773–775.
3.
Steere AC, Malawista SE, Hardin JA, Ruddy S, Askenase PW, Andiman WA: Erythema chronicum migrans and Lyme arthritis: The enlarging clinical spectrum. Ann Intern Med 1977;86:685–698.
4.
Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldt E, Davis JP: Lyme disease – A thick-borne spirochetosis? Science 1982;216:1317–1319.
5.
Williams HC, Strachan DP (eds): The Challenge of Dermatoepidemiology. New York, CRC Press, 1997.
6.
Hartge P, Devesa SS: Quantification of the impact of known risk factors on time trends in non-Hodgkin’s lymphoma incidence. Cancer Res 1992;52:5566–5569S.
7.
Rothman KJ, Greenland S: Modern Epidemiology, ed 2. Philadelphia, Lippincott-Raven, 1998, pp 459–480.
8.
Munksgaard L, Frisch M, Melbye M, Hjalgrim H: Incidence patterns of Lyme disease and cutaneous B-cell non-Hodgkin’s lymphoma in the United States. Dermatology 2000;201:351–352.
9.
Greenland S, Robins J: Invited commentary: Ecologic studies – Biases, misconceptions and counter-examples. Am J Epidemiol 1994;139:747–760.
10.
Brenner H, Savitz DA, Gefeller O: Effects of nondifferential exposure misclassification in ecologic studies. Am J Epidemiol 1992;135:85–95.
11.
Bentham G: Association between incidence of non-Hodgkin’s lymphoma and solar ultraviolet radiation in England and Wales. Br Med J 1996;312:1128–1131.
12.
Newton R: American data refute ultraviolet hypothesis. Br Med 1995;311:749.
13.
Newton R: Solar ultraviolet radiation is not a major cause of primary cutaneous non-Hodgkin’s lymphoma. Br Med J 1997;314:1483.
14.
Adami J, Gridley G, Nyren O, Dosemeci M, Linet M, Glimelius B, Ekbom A, Zahm SH: Sunlight and non-Hodgkin’s lymphoma: A population-based study in Sweden. Int J Cancer 1999;80:641–645.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.