High Childhood Leukemia Mortality Rates in Mexico Associated to Water Contamination in Areas of Oil and Gas Extraction.

Acute lymphoblastic leukemia (ALL) is the leading cause of death in Mexican children, yet water-mediated environmental pathways remain largely unexplored as contributors to its spatial distribution. We analyzed ALL mortality records for individuals aged 0-19 years across all Mexican municipalities from 2003 to 2023, using publicly available national death statistics and population estimates. Age-specific mortality rates were calculated at the municipal level and aggregated to the state level to characterize broad geographic gradients. A discrete Poisson spatial scan statistic, implemented in SaTScan, identified 10 statistically significant mortality clusters, five with elevated risk and five with reduced risk, which were then compared against hydrogeological and industrial variables derived from global remote sensing and infrastructure databases. The national mortality rate averaged 1.64 per 100,000 children aged 0-19, with state-level rates ranging more than two-fold from 1.01 in Durango to 2.35 in Tabasco. High-mortality clusters are concentrated along the Gulf of Mexico coast and southeastern states; low-mortality zones lie predominantly in the arid west and northwest. High-mortality areas are systematically characterized by greater annual precipitation, lower aridity, permeable sedimentary geology, and higher forest cover-landscape conditions that collectively maximize infiltration and groundwater contamination risk. All five high-mortality clusters spatially overlap with oil and gas infrastructure, with three coinciding with zones of intensive extraction along the Gulf coast. These findings suggest that groundwater vulnerability and industrial contamination, rather than genetic predisposition, are primary spatial determinants of childhood ALL mortality in Mexico, pointing toward preventable, structurally driven disease burden.