Richard G Feltbower

Publications of Richard G Feltbower

• Space-time clustering of childhood central nervous system tumours in Yorkshire, UK.

  Authors: Richard Jq McNally, Peter W James, Susan V Picton, Patricia A McKinney, Marlous van Laar, Richard G Feltbower

  BMC cancer. 01/2012; 12:13.

  ABSTRACT: We specifically tested the aetiological hypothesis that a factor influencing geographical or temporal heterogeneity of childhood central nervous system (CNS) tumour incidence was related toABSTRACT: We specifically tested the aetiological hypothesis that a factor influencing geographical or temporal heterogeneity of childhood central nervous system (CNS) tumour incidence was related to exposure to a transient environmental agent. Information was extracted on individuals aged 0-14 years, diagnosed with a CNS tumour between the 1st January 1974 and 31st December 2006 from the Yorkshire Specialist Register of Cancer in Children and Young People. Ordnance Survey eight-digit grid references were allocated to each case with respect to addresses at the time of birth and the time of diagnosis, locating each address to within 0.1 km. The following diagnostic groups were specified a priori for analysis: ependymoma; astrocytoma; primitive neuroectodermal tumours (PNETs); other gliomas; total CNS tumours. We applied the K-function method for testing global space-time clustering using fixed geographical distance thresholds. Tests were repeated using variable nearest neighbour (NN) thresholds. There was statistically significant global space-time clustering for PNETs only, based on time and place of diagnosis (P = 0.03 and 0.01 using the fixed geographical distance and the variable NN threshold versions of the K-function method respectively). There was some evidence for a transient environmental component to the aetiology of PNETs. However, a possible role for chance cannot be excluded.

• Creating a national register of childhood type 1 diabetes using routinely collected hospital data.

  Authors: Susan Hodgson, Linda Beale, Roger C Parslow, Richard G Feltbower, Lars Jarup

  Pediatric diabetes. 10/2011;

  Hodgson S, Beale L, Parslow RC, Feltbower RG, Jarup L. Creating a national register of childhood type 1 diabetes using routinely collected hospital data. Introduction: There is no national registerHodgson S, Beale L, Parslow RC, Feltbower RG, Jarup L. Creating a national register of childhood type 1 diabetes using routinely collected hospital data. Introduction: There is no national register of childhood type 1 diabetes mellitus for England. Our aim was to assess the feasibility of using routine hospital admissions data as a surrogate for a childhood diabetes register across England, and to create a geographically referenced childhood diabetes dataset for use in epidemiologic studies and health service research. Methods: Hospital Episodes Statistics data for England from April 1992 to March 2006 referring to a type 1 diabetes diagnosis in 0-14 yr olds were cleaned to approximate an incident dataset. The cleaned data were validated against regional population-based register data, available for Yorkshire and the area of the former Oxford Regional Health Authority. Results: There were 32 665 unique cases of type 1 and type unknown diabetes over the study period. The hospital-derived data improved in quality over time (91% concordance with regional register data over the period 2000-2006 vs. 52% concordance over the period 1992-1999), and data quality was better for younger (0-9 yr) (86.5% concordance with regional register data) than older cases (10-14 yr). Overall incidence was 24.99 (95% confidence interval 24.71-25.26) per 100 000. Basic trends in age distribution, seasonality of onset, and incidence matched well with previously reported findings. Conclusion: We were able to create a surrogate register of childhood diabetes based on national hospital admissions data, containing approximately 2300 cases/yr, and geo-coded to a high resolution. For younger cases (0-9 yr) and more recent years (from 2000) these data will be a useful resource for epidemiological studies exploring the determinants of childhood diabetes.

• Resource and outcome in paediatric diabetes services.

  Authors: Katie L Harron, Patricia A McKinney, Richard G Feltbower, Philip Holland, Fiona M Campbell, Roger C Parslow

  Archives of disease in childhood. 05/2011;

  The availability of resource (staffing and services) in all 21 paediatric diabetes services in Yorkshire and Humber Strategic Health Authority, UK was surveyed and this information was combined withThe availability of resource (staffing and services) in all 21 paediatric diabetes services in Yorkshire and Humber Strategic Health Authority, UK was surveyed and this information was combined with demographic and clinical data on 2683 children and young people with diabetes (aged 0-23 years) to assess whether level of resource was associated with glycaemic control (mean HbA1c %). Multilevel modelling and graphical techniques were used to analyse the relationship between resource and outcome for paediatric diabetes services. No services achieved all resource recommendations based on National Institute for Health and Clinical Excellence guidelines, but there was no direct association between level of resource and glycaemic control after controlling for deprivation, age and duration of diabetes. Transitional care, nurse caseload and access to specialist services are not adequately resourced but variation in outcome between services is not accounted for by level of resource.

• Referral to a specialist paediatric palliative care service in oncology patients.

  Authors: Lorna K Fraser, Michael Miller, Patricia A McKinney, Roger C Parslow, Richard G Feltbower

  Pediatric blood & cancer. 04/2011; 56(4):677-80.

  Cancer is the second most common cause of death in children and young people (0-19 years) accounting for 16.2% of deaths in England and Wales in 2005. Only 37.6% children and young people who diedCancer is the second most common cause of death in children and young people (0-19 years) accounting for 16.2% of deaths in England and Wales in 2005. Only 37.6% children and young people who died from cancer in Yorkshire were referred to Martin House Children's Hospice (MH) during the period 1990-2005. A significantly higher proportion with central nervous system tumours and a significantly lower than expected proportion with leukaemia or lymphoma were referred for palliative care. There is potential to increase the proportion of children and young people with cancer who are referred to specialist palliative care services.

• Treatment and survival patterns for germ cell tumors among 13- to 24-year olds in Yorkshire, UK.

  Authors: Richard G Feltbower, Catherine Siller, Emma Woodward, Patricia A McKinney, Susan V Picton, Jonathan Joffe, Daniel P Stark

  Pediatric blood & cancer. 02/2011; 56(2):282-8.

  Teenage and young adult (TYA) patient care can fall into gaps between adult and children's services. Increasingly UK TYA multi-disciplinary teams manage germ cell tumors (GCT) in locally agreedTeenage and young adult (TYA) patient care can fall into gaps between adult and children's services. Increasingly UK TYA multi-disciplinary teams manage germ cell tumors (GCT) in locally agreed collaborations and age ranges. Patterns of care are changing rapidly. However, between disciplines protocols define different assessment and management in GCT. We aimed to document changes in incidence, treatment, and survival since 1990, to record the baseline to which future trends can be compared. Details were extracted from the UK population-based Yorkshire Specialist Cancer Register on 237 TYA aged 13-24 years diagnosed with a GCT between 1990 and 2004, followed-up until 2009. Incidence and survival patterns were assessed using Poisson and Cox regression. Testicular (n = 190; 80%) and ovarian (n = 22; 9%) GCT were the most common malignancies, and 90% of GCT occurred aged 17-24 years. The overall incidence rate was 26.9 per million person years. Rates increased significantly by 4.0% (95% CI: 1.0-7.1%) per year on average. The most common treatment modality was surgery combined with chemotherapy (49%). Initial treatment changed significantly over time (P = 0.003) and by age (P = 0.005). There were significant differences in the management of stage 1 testicular tumors by age. Among 13- to 16-year olds, 56% were treated exclusively in adult departments. Five-year survival rates were 93-95% for gonadal GCT, and 70-75% for other sites. Survival did not differ by age (P = 0.65) or period (P = 0.41). The age-related differences observed in the approach to GCT treatment suggest a collaborative approach to the models of care among TYA is required.

• Rising rates of all types of diabetes in south Asian and non-south Asian children and young people aged 0-29 years in West Yorkshire, U.K., 1991-2006.

  Authors: Katie L Harron, Richard G Feltbower, Patricia A McKinney, H Jonathan Bodansky, Fiona M Campbell, Roger C Parslow

  Diabetes care. 01/2011; 34(3):652-4.

  To investigate incidence trends of all diabetes types in all children and young people and in the south Asian subpopulation. Annual incidence per 100,000 and time trends (1991-2006) were analyzed forTo investigate incidence trends of all diabetes types in all children and young people and in the south Asian subpopulation. Annual incidence per 100,000 and time trends (1991-2006) were analyzed for 2,889 individuals aged 0-29 years diagnosed with diabetes while resident in West Yorkshire, U.K. Diagnoses comprised type 1 (83%), type 2 (12%), maturity-onset diabetes of the young (0.7%), "J"-type/other (0.1%), and uncertain/unclassified (4%). There was a lower incidence of type 1 and a threefold excess of type 2 in south Asians compared with non-south Asians. Type 1 incidence leveled out and type 2 increased after the first south Asian case of type 2 was diagnosed in 1999. Type 2 and unclassified diabetes incidence rose in all population subgroups. The burden of diabetes increased over time for both ethnic groups, with a significant excess of type 2 diabetes in south Asians. The rising incidence of type 1 diabetes in south Asians attenuated as type 2 diabetes increased after 1999.

• The epidemiology of bone cancer in 0 - 39 year olds in northern England, 1981 - 2002.

  Authors: Rachel Eyre, Richard G Feltbower, Peter W James, Karen Blakey, Emmanuel Mubwandarikwa, David Forman, Patricia A McKinney, Mark S Pearce, Richard J Q McNally

  BMC cancer. 01/2010; 10:357.

  There is a paucity of recent epidemiological data on bone cancers. The aim of this study was to describe incidence and survival patterns for bone cancers diagnosed during 1981 - 2002. Cases aged 0 -There is a paucity of recent epidemiological data on bone cancers. The aim of this study was to describe incidence and survival patterns for bone cancers diagnosed during 1981 - 2002. Cases aged 0 - 39 years (236 osteosarcomas, 166 Ewing sarcomas and 73 chondrosarcomas) were analysed using Poisson and Cox regressions. Incidence rates (per million persons per year) for osteosarcoma were 2.5 at age 0 - 14 years; 4.5 at age 15 - 29 years and 1.0 at age 30 - 39 years. Similarly, for Ewing sarcoma the incidence rates were 2.2; 2.9; 0.4 and for chondrosarcoma rates were 0.1; 1.2; 1.8 respectively. Incidence of osteosarcoma increased at an average annual rate of 2.5% (95% CI 0.4 - 4.7; P = 0.02), but there was no change in incidence of Ewing sarcoma or chondrosarcoma. There was a marginally statistically significant improvement in survival for Ewing sarcoma (hazard ratio (HR) per annum = 0.97; 95% CI 0.94 - 1.00; P = 0.06), although patients aged 15 - 39 years (n = 93) had worse overall survival than those aged 0 - 14 (n = 73; HR = 1.46; 95% CI 0.98 - 2.17; P = 0.06). There was no significant improvement in osteosarcoma survival (HR per annum = 0.98; 95% CI 0.95 - 1.01; P = 0.18). Reasons for poorer survival in Ewing sarcoma patients aged 15 - 39 years and failure to significantly improve survival for osteosarcoma patients requires further investigation.

• Epidemiology of bone tumours in children and young adults.

  Authors: Rachel Eyre, Richard G Feltbower, Emmanuel Mubwandarikwa, Tim O B Eden, Richard J Q McNally

  Pediatric blood & cancer. 08/2009;

  Although the epidemiology of malignant bone tumours in children and young adults has been explored, no definitive causation of any specific tumour has yet been identified. We performed a literatureAlthough the epidemiology of malignant bone tumours in children and young adults has been explored, no definitive causation of any specific tumour has yet been identified. We performed a literature review (1970-2008) to find all papers covering possible aetiological factors involved in the development of bone tumours in children and young adults. Several associations have been reported with some consistency: the presence of hernias and Ewing sarcoma; high fluoride exposure and osteosarcoma; and parental farming and residence on a farm, younger age at puberty and family history of cancer for all bone tumours, especially osteosarcoma. Clearly further research is needed to confirm or refute these putative risk factors. It is likely that studies of gene-environment interactions may prove to be the most fruitful of future research. Pediatr Blood Cancer. (c) 2009 Wiley-Liss, Inc.

• Epidemiology of leukaemia and lymphoma in children and young adults from the north of England, 1990-2002.

  Authors: Richard G Feltbower, Richard J Q McNally, Sally E Kinsey, Ian J Lewis, Susan V Picton, Stephen J Proctor, Michael Richards, Geoff Shenton, Rod Skinner, Daniel P Stark, Josef Vormoor, Kevin P Windebank, Patricia A McKinney

  European journal of cancer (Oxford, England : 1990). 12/2008;

  AIM: We aimed to describe and contrast the epidemiology of haematological malignancies among 0-14 and 15-24-year-olds in northern England from 1990 to 2002 and compare clinical trial entry by ageAIM: We aimed to describe and contrast the epidemiology of haematological malignancies among 0-14 and 15-24-year-olds in northern England from 1990 to 2002 and compare clinical trial entry by age group. PATIENTS AND METHODS: Incidence rates were examined by age, sex and period of diagnosis and differences were tested using Poisson regression. Differences and trends in survival were assessed using Cox regression. RESULTS: 1680 subjects were included comprising 948 leukaemias and 732 lymphomas. Incidence rates for acute lymphoblastic leukaemia were significantly higher for 0-14 compared to 15-24-year-olds, whilst Hodgkin lymphoma showed the reverse. No significant changes in incidence were observed. 60% of leukaemia patients aged 15-24 years entered trials compared to 92% of 0-14-year-olds. Survival rates were significantly lower and improved less markedly over time for 15-24 compared to 0-14-year-olds, particularly for leukaemia. CONCLUSIONS: Trial accrual rates need to be improved amongst 15-24-year-olds and a more structured follow-up approach adopted for this unique population.

• THE UK CHILDHOOD CANCER STUDY: MATERNAL OCCUPATIONAL EXPOSURES AND CHILDHOOD LEUKAEMIA AND LYMPHOMA.

  Authors: Patricia A McKinney, Olaide Y Raji, Martie van Tongeren, Richard G Feltbower

  Radiation protection dosimetry. 11/2008;

  Risks of childhood leukaemia and lymphoma were investigated for specific work-related exposures of mothers in the UK Childhood Cancer Study. Interviews with parents of 1881 leukaemia and lymphomaRisks of childhood leukaemia and lymphoma were investigated for specific work-related exposures of mothers in the UK Childhood Cancer Study. Interviews with parents of 1881 leukaemia and lymphoma cases (0-14 years) and 3742 controls collected job histories recording exposure to eight specific agents. Exposure was (1) self-reported and (2) reviewed, based mainly on exposure probability and exposure level. Completeness, consistency and sufficiency evaluated data quality. Of all job exposures which were self-reported as exposed, 33% cases and 34% controls remained classified as exposed after review, with the remainder designated as partially exposed or unexposed. No review of underreporting of exposure was made. Data quality was 'good' for 26% of cases and 24% of controls. For self-reported exposure, significant risks of acute lymphoblastic leukaemia (ALL) were observed for solvents and petrol in all time windows. For reviewed exposure, solvents remained significant for ALL during pregnancy and postnatally. Restricting analyses to good-quality information removed all significant results. Refinement of exposure assessment revealed misclassification of self-reported exposures and data quality influenced risk assessment. Maternal exposure to solvents should further be investigated. These findings must invoke caution in the interpretation of risks reliant on self-reported occupational data.

• What do epidemiologists mean by 'population mixing'?

  Authors: Graham R Law, Richard G Feltbower, John C Taylor, Roger C Parslow, Mark S Gilthorpe, Paul Boyle, Patricia A McKinney

  Pediatric blood & cancer. 09/2008; 51(2):155-60.

  There is growing evidence that some chronic diseases are caused, or promoted, by infectious disease. 'Population mixing' has been used as a proxy for the range and dose of infectious agentsThere is growing evidence that some chronic diseases are caused, or promoted, by infectious disease. 'Population mixing' has been used as a proxy for the range and dose of infectious agents circulating in a community. Given the speculation over the role of population mixing in many chronic diseases, we review the various methods used for measuring population mixing, and provide a classification of these. We recommend that authors fulfill two criteria in publications: measures are demonstrably associated with the putative risk factors for which population-mixing is acting as a proxy and fundamental characteristics of the chosen measures are clearly defined.

• Measuring the school impact on child obesity.

  Authors: Kimberley L Procter, Mary C Rudolf, Richard G Feltbower, Ronnie Levine, Anne Connor, Michael Robinson, Graham P Clarke

  Social science & medicine (1982). 08/2008; 67(2):341-9.

  This article explores the impact that schools have on their pupils' obesity and so identify those where targeted input is most needed. A modelling process was developed using data that had beenThis article explores the impact that schools have on their pupils' obesity and so identify those where targeted input is most needed. A modelling process was developed using data that had been collected over 2 years on a socio-economically and ethnically representative sample of 2367 school pupils aged 5 and 9 years old attending 35 Leeds primary schools. The three steps in the model involved calculating the "Observed" level of obesity for each school using mean body mass index standard deviation (BMI SDS); adjusting this using ethnicity and census-derived deprivation data to calculate the "Expected" level; and calculating the "Value Added" by each school from differences in obesity at school entry and transfer. We found there was significant variance between the schools in terms of mean BMI SDS (range -0.07 to +0.78). Residential deprivation score and ethnicity accounted for only a small proportion of the variation. Expected levels of obesity therefore differed little from the Observed, but the Value Added step produced very different rankings. As such, there is variation between schools in terms of their levels of obesity. Our modelling process allowed us to identify schools whose levels differed from that expected given the socio-demographic make up of the pupils attending. The Value Added step suggests that there may be a significant school effect. If this is validated in extended studies, the methodology could allow for exploration of mechanisms contributing to the school effect, and identify schools with the highest unexpected prevalence. Resources could then be targeted towards those schools in greatest need.

• Evaluation of bone mass in children with long bone fracture compared with controls.

  Authors: Joanne H Bradshaw, Philip Holland, Richard G Feltbower

  Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America. 07/2008; 17(4):159-63.

  Childhood is a critical period for achieving skeletal mass. In adults, low bone density is associated with an increased fracture risk and it has been postulated that the same is true for children. IfChildhood is a critical period for achieving skeletal mass. In adults, low bone density is associated with an increased fracture risk and it has been postulated that the same is true for children. If this were the case, we would expect that children with fractures might have a lower bone mass than those without. A case-control study of 30 cases and 30 age and sex-matched controls was carried out. Each child underwent height and weight measurements, a simple interview and phalangeal ultrasound to measure speed of sound. The difference in mean speed of sound was -51.81 m/s (95% confidence interval -83.0 to -20.6; P=0.002) in children with simple long bone fractures versus controls. In children, there appears to be a significant difference in bone mass between those with a simple long bone fracture and those who have never sustained a fracture. To be certain that this is owing to cause rather than effect, and also as this is an important public health issue, further studies are warranted.

• Acute complications and drug misuse are important causes of death for children and young adults with type 1 diabetes: results from the Yorkshire Register of diabetes in children and young adults.

  Authors: Richard G Feltbower, H Jonathan Bodansky, Christopher C Patterson, Roger C Parslow, Carolyn R Stephenson, Catherine Reynolds, Patricia A McKinney

  Diabetes care. 05/2008; 31(5):922-6.

  OBJECTIVE: To examine mortality rates and causes of death among subjects diagnosed with type 1 diabetes aged <or=29 years. RESEARCH DESIGN AND METHODS: Subjects with type 1 diabetes from aOBJECTIVE: To examine mortality rates and causes of death among subjects diagnosed with type 1 diabetes aged <or=29 years. RESEARCH DESIGN AND METHODS: Subjects with type 1 diabetes from a population-based register in Yorkshire, U.K., diagnosed between 1978 and 2004 were linked to the U.K. National Health Service Central Register for death notifications. Deaths were coded using ICD-9 (1979-2000) and ICD-10 (2001-2005). Standardized mortality ratios (SMRs) were calculated using expected numbers of deaths from U.K. mortality rates by cause of death and age at diagnosis. RESULTS: A total of 4,246 individuals were followed up, providing 50,471 person-years of follow-up. Mean follow-up length was 12.8 years for individuals aged 0-14 years and 8.3 for those aged 15-29 years. Overall, 108 patients died, of whom 77 (71%) were male. A total of 74 (1.7/1,000 person-years) deaths occurred in inidividuals aged 0-14 years and 34 (4.6/1,000 person-years) in those aged 15-29 years. The SMR was 4.7 (95% CI 3.8-5.6) overall, similar for males and females, but higher for individuals aged 15-29 years (SMR 6.2 [95% CI 4.3-8.6]) compared with those aged 0-14 years (4.2 [3.3-5.3]). The SMR rose with increasing disease duration. A total of 47 of 108 deaths (44%) occurred from diabetes complications, 32 of which were acute and 15 chronic. Twenty-two percent (n = 24) of deaths were attributed to accidents or violence (SMR 2.1 [95% CI 1.4-3.2]), including six suicides. Sixteen percent of all deaths were related to drug misuse (including insulin but excluding tobacco and alcohol) (SMR 6.4 [95% CI 3.7-10.2]). CONCLUSIONS: Subjects with type 1 diabetes diagnosed under 30 years of age had a 4.7-fold excess mortality risk. Nearly half of the deaths were due to acute or chronic complications of diabetes. Drug misuse-related deaths may be an emerging trend in this population warranting further investigation.

• Childhood acute lymphoblastic leukaemia in relation to population mixing around the time of birth in South Hungary.

  Authors: John C Taylor, Richard G Feltbower, Patricia A McKinney, Roger C Parslow, Graham R Law

  Pediatric blood & cancer. 01/2007; 47(7):974; author reply 975.

• Childhood leukaemias and CNS tumours: correlation of international incidence rates.

  Authors: Sarah J Hepworth, Richard G Feltbower, Patricia A McKinney

  European journal of cancer (Oxford, England : 1990). 04/2006; 42(4):509-13.

  Childhood leukaemia has a potential infectious aetiology whilst infections may also be linked to paediatric central nervous system (CNS) tumours. Using data from 29 countries we investigated theChildhood leukaemia has a potential infectious aetiology whilst infections may also be linked to paediatric central nervous system (CNS) tumours. Using data from 29 countries we investigated the correlation between international incidence rates of childhood leukaemia and CNS tumours, focusing on acute lymphoblastic leukaemia (ALL), astrocytoma and ependymoma-subtypes that are hypothesised to have an infectious aetiology. Relationships between incidence rates and national demographic factors were also examined using Pearson's correlation coefficient to quantify associations. Comparing two diagnostic categories of leukaemia with four groups of CNS tumours, a highly significant positive correlation was found between ALL and astrocytoma (r = 0.57, P = 0.002). Higher rates of ALL and CNS tumours were associated with increased affluence, with the strongest correlation for Gross Domestic Product per capita and CNS tumours (r = 0.70, P < 0.001). National incidence rates of childhood ALL and astrocytomas were highly correlated and this may reflect a common environmental cause whose origin may be infectious in nature. International incidence of ALL and CNS tumours were also correlated with economic related factors. Variation in levels of ascertainment may partially explain this, although childhood environmental exposures related to infections will also be affected by levels of affluence.

• Childhood cancer and power lines: results do not support causal role for electromagnetic fields.

  Authors: Sarah J Hepworth, Richard G Feltbower, Roger C Parslow, Patricia A McKinney

  BMJ (Clinical research ed.). 10/2005; 331(7517):634-5; discussion 636; author reply 636-7.

• Detecting small-area similarities in the epidemiology of childhood acute lymphoblastic leukemia and diabetes mellitus, type 1: a Bayesian approach.

  Authors: Richard G Feltbower, Samuel O M Manda, Mark S Gilthorpe, Mel F Greaves, Roger C Parslow, Sally E Kinsey, H Jonathan Bodansky, Patricia A McKinney

  American journal of epidemiology. 07/2005; 161(12):1168-80.

  Childhood acute lymphoblastic leukemia and diabetes mellitus, type 1, have common epidemiologic and etiologic features, including correlated international incidence and associations with infections.Childhood acute lymphoblastic leukemia and diabetes mellitus, type 1, have common epidemiologic and etiologic features, including correlated international incidence and associations with infections. The authors examined whether the diseases' similar large-scale distributions are reflected in small geographic areas while also examining the influence of sociodemographic characteristics. Details of 299 children (0-14 years) with acute lymphoblastic leukemia and 1,551 children with diabetes diagnosed between 1986 and 1998 were extracted from two registers in Yorkshire, United Kingdom. Standardized incidence ratios across 532 electoral wards were compared using Poisson regression, confirming significant associations between population mixing and the geographic heterogeneity of both conditions. Bayesian methods analysis of spatial correlation between diseases by modeling a bivariate outcome based on their standardized incidence ratios was applied; spatial and heterogeneity components were included within a hierarchical random effects model. A positive correlation between diseases of 0.33 (95% credible interval: -0.20, 0.74) was observed, and this was reduced after control for population mixing (r = 0.18), population density (r = 0.14), and deprivation (r = 0.06). The Bayesian approach showed a modest but nonsignificant joint spatial correlation between diseases, only partially suggesting that the risk of both was associated within some electoral wards. With Bayesian methodology, population mixing remained significantly associated with both diseases. The links between diabetes and acute lymphoblastic leukemia observed for large regions are weaker for small areas. More powerful replications are needed for confirmation of these findings.