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Analysis of matched geographical areas to study potential links between environmental exposure to oil refineries and non-Hodgkin lymphoma mortality in Spain

Rebeca Ramis123*, Peter Diggle3, Elena Boldo12, Javier Garcia-Perez12, Pablo Fernandez-Navarro12 and Gonzalo Lopez-Abente12

Author Affiliations

1 Department of Environmental Epidemiology and Cancer, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain

2 Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública--CIBERESP), Madrid, Spain

3 Faculty of Health and Medicine, Lancaster University, Lancaster, UK

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International Journal of Health Geographics 2012, 11:4  doi:10.1186/1476-072X-11-4

Published: 6 February 2012



Emissions from refineries include a wide range of substances, such as chrome, lead, nickel, zinc, arsenic, cadmium, benzene, dioxins and furans, all of which are recognized by the International Agency for Research on Cancer (IARC) as carcinogens.

Various studies have shown an association between non-Hodgkin lymphoma (NHL) and residence in the vicinity of industrial areas; however, evidence of specific association between refineries and residence in the vicinity has been suggested but not yet established.

The aim of this study is to investigate potential links between environmental exposure to emissions from refineries and non-Hodgkin lymphoma mortality in Spain.

The spatial distribution of NHL in Spain has an unusual pattern with regions some showing higher risk than others.


We designed an analysis of matched geographical areas to examine non-Hodgkin lymphoma mortality in the vicinity of the 10 refineries sited in Spain over the period 1997-2006. Population exposure to refineries was estimated on the basis of distance from town of residence to the facility in a 10 km buffer.

We defined 10 km radius areas to perform the matching, accounting for population density, level of industrialization and socio-demographic factors of the area using principal components analysis.

For the matched towns we evaluated the risk of NHL mortality associated with residence in the vicinity of the refineries and with different regions using mixed Poisson models. Then we study the residuals to assess a possible risk trend with distance.


Relative risks (RRs) associated with exposure showed similar values for women and for men, 1.09 (0.97-1.24) and 1.12 (0.99-1.27). RRs for two regions were statistically significant: Canary Islands showed an excess of risk of 1.35 (1.05-1.72) for women and 1.50 (1.18-1.92) for men, whilst Galicia showed an excess of risk of 1.35 (1.04-1.75) for men, but not significant excess for women.


The results suggest a possible increased risk of NHL mortality among populations residing in the vicinity of refineries; however, a potential distance trend has not been shown. Regional effects in the Canary Islands and Galicia are significantly greater than the regional average.

Non-Hodgkin lymphoma; Refinery; Pollution; Mortality; Matched analysis