Limitations
Notable limitations of this work are difficult to lift. A major
limitation are the data used from literature and reviews with varying
collection periods which span numerous years (Table 1 ).
Disparate time scales occasionally underlie epidemiological studies of
CMV in the low-income greater neighborhoods. There, the prevailing
cultural settings and areas of higher deprivation (with highest
prevalence of CMV infection) frequently overlap confounding the measured
estimates (Table 2 ). Small numbers yield unstable prevalence
rates. The roundabouts of more disadvantageous neighborhoods, culturally
and genetically distinct yet sharing remotely entangled backgrounds,
often overlay and may affect accuracy and consistency of the estimates.
Race and ethnicity were differently categorized by the investigators.
Also, the options were defined by study participants. Marked disparity
between African Americans and White patients might have resulted from
different indication settings for CMV testing and in unknown
proportions. Also, there still remains a possibility that, besides the
CMV, there could have existed yet another causative tumor-suppressive
agent. Consequently, formal adjudication of causality of statistical
significance is not allowed by the cross-sectional nature of the data in
many studies we used. Still, prospective studies suggest that causality
could be at work behind significance of statistical tests; high degree
of disparity between Blacks and Whites is unlikely to result solely as
an artifact of testing biases. Pronounced variance in cancer incidence
in AI/AN reported by Henley et al. [44] and Cronin et
al . [45] are possibly due to improved financial attainment and
hygiene, cleaning, and the privilege of preventive medical care although
a drop of CMV prevalence in this populace has not yet been accurately
registered. The New Zealand Islanders’ CMV seropositivity estimates
presented here (Table 1 ) may crudely parallel those in APIs who
live on the U.S. Pacific Island Territories rather than that of API
migrants living on the U.S. mainland. The estimates should be considered
with circumspection and checked with regard to future vaccination
strategies to fight CMV infection [64]. We have to take the results
presented here within the context of these limitations.