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.