Diabetes and social class

Type 1 Diabetes incidence among youth in Utah: A geographical analysis

Type 1 Diabetes (T1D) poses an increasing threat to public health, as incidence rates continue to rise globally. However, the etiology of T1D is still poorly understood, especially from the perspective of geography. The objective of this research is to examine the incidence of T1D among youth and to identify high-risk clusters and their association with socio-demographic and geographic variables. The study area was the entire state of Utah and included youth with T1D from birth to 19 years of age from 1998 to 2015 (n = 4161). Spatial clustering was measured both globally and locally using the Moran's I statistic and spatial scan statistic. Ordinary least squares (OLS) regression was used to measure the association of high-risk clusters with certain risk factors at the Census Block Group (CBG) level. The mean age at diagnosis was 9.3 years old. The mean incidence rate was 25.67 per 100,000 person-years (95% CI, 24.57-26.75). The incidence rate increased by 14%, from 23.94 per100,000 person-years in 1998 to 27.98 per 100,000 person-years in 2015, with an annual increase of 0.80%. The results of the spatial scan statistic found 42 high-risk clusters throughout the state. OLS regression analysis found a significant association with median household income, population density, and latitude. This study provides evidence that incidence rates of T1D are increasing annually in the state of Utah and that significant geographic high-risk clusters are associated with socio-demographic and geographic factors.

Causes and predictors of mortality among Ghanaians hospitalised with endocrine disorders

Background

Endocrine disorders have been noted to be on the increase in the developing world, but little is known about their outcomes on the African continent.

Methods

We conducted a retrospective longitudinal study to evaluate the demographic characteristics and determinants of endocrine-related mortality among adult patients over 9 y in a leading tertiary hospital in Ghana. We determined the predictors of inpatient mortality using Kaplan–Meier survival curves and Cox proportional hazard regression analysis.

Results

Overall, 6265 patients (9.7% of all medical admissions) were admitted with various endocrine disorders during the period. The most common endocrine cause of hospitalisation was diabetes mellitus (86.0%), followed in order of decreasing frequency by thyroid disorders (7.7%) and miscellaneous disorders (1.4%). The overall crude mortality rate of endocrine admissions was 16.7%. Death was predicted by increasing age with an adjusted hazard ratio of 1.25 (95% confidence interval 1.15 to 1.65) for every 10-y increase in age.

Conclusions

Almost one in six adults admitted with an endocrine disorder to a tertiary care centre in Ghana died in hospital, and many of the deaths were due to non-communicable disease complications. Enhanced public health disease prevention strategies and endocrine inpatient care processes are warranted.

Type I diabetes among children and young adults: the role of country of birth, socioeconomic position and sex

OBJECTIVE

To investigate associations between country of birth, parental country of birth, and education with respect to incidence rate and time trends of type 1 diabetes mellitus (T1DM) among children and young adults.

METHODS

We followed a nation-wide cohort of 4 469 671 males and 4 231 680 females aged 0-30 years between 1969 and 2008. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for T1DM were calculated using Poisson regression models. We further calculated age-standardized rates (ASRs) of T1DM, using the world population as standard.

RESULTS

During the study period, the ASR of T1DM increased among children younger than 15 years, but not among young adults (15-30 years). Compared with Swedish-born children, male and female immigrant children had 44 and 42% lower IRR of TIDM, respectively. Among offspring to immigrants, corresponding decreases in IRRs were 27 and 24%, respectively. Compared with children to parents with high education, male children to parents with low education had a 10% decreased IRR of T1DM, while no effect was observed among females. The IRR of T1DM increased with increasing age and calendar time of follow-up in both sexes (p-for trend <0.0001). In young adults, the IRR among immigrants decreased by 32% in males and 22% in females, while corresponding reductions in IRRs were less in offspring to immigrants.

CONCLUSIONS

We found a lower IRR of T1DM among offspring to immigrants, but especially among young immigrants compared with Sweden-born individuals. The findings show that environmental factors are important in the etiology of T1DM.

Independent effects of socioeconomic status and place of residence on the incidence of childhood type 1 diabetes in Western Australia

OBJECTIVE

To analyze the incidence of type 1 diabetes in 0- to 14-year olds in Western Australia, from 1985 to 2002, by region and socioeconomic status.

METHODS

Primary case ascertainment was from the prospective population-based Western Australian Diabetes Register, and secondary case ascertainment was from the Western Australian Hospital Morbidity Data System. The address at diagnosis was used to categorize cases into urban, rural and remote areas and into five socioeconomic groups using the Index of Relative Socioeconomic Disadvantage. Denominator data were obtained from the Australian Bureau of Statistics. Poisson regression was used to analyze the incidence rates by area and socioeconomic status.

RESULTS

There were a total of 1143 cases (904 urban, 190 rural and 49 remote). Case ascertainment was estimated to be 99.8% complete. The mean annual age-standardized incidence from 1985 to 2002 was 18.1 per 100,000 person years in urban (95% CI: 16.3-19.9), 14.3 per 100,000 in rural (95% CI: 11.4-7.3) and 8.0 per 100,000 in remote areas (95% CI: 5.8-10.3). The incidence was significantly higher in urban compared with rural (rate ratio 1.27, p = 0.001) and remote (rate ratio 2.28, p < 0.001) areas. The incidence increased with higher socioeconomic status. The incidence in the highest socioeconomic group was 56% greater than the lowest socioeconomic group (rate ratio 1.56, p < 0.001). These differences in incidence by socioeconomic status and region were independent of each other.

CONCLUSIONS

Higher socioeconomic status and residence in the urban area are independently associated with an increased risk of childhood type 1 diabetes in Western Australia.

The Belgrade childhood diabetes study: a multivariate analysis of risk determinants for diabetes

BACKGROUND

The aim of this study was to evaluate some hypotheses about factors related to the development of type 1 diabetes mellitus.

METHODS

A case-control study was conducted in Belgrade during the period 1994-1997. A total of 105 recently onset diabetic and 210 control children, individually matched by age (+/-1 year), sex and place of residence, were included in the study.

RESULTS

According to multivariate regression analysis, the following factors were related to type 1 diabetes: stressful events and symptoms of psychological dysfunction during the 12 months preceding the onset of the disease [odds ratio (OR) 3.48, 95% confidence interval (CI) 2.15-5.65; and OR 2.15, 95% CI 1.33-3.48], irregular vaccination (OR 16.98, 95% CI 1.38-208.92), infection during 6 months preceding the onset of the disease (OR 4.23, 95% CI 1.95-9.17), higher education of father (OR 1.50, 95% CI 1.05-2.14), mother's consumption of nitrosoamines-rich food during pregnancy (OR 4.33, 95% CI 1.95-9.61), alcohol consumption by father (OR 3.80, 95% CI 1.64-8.78), insulin-dependent and non-insulin-dependent diabetes mellitus in three generations of children's relatives (OR 20.04, 95% CI 4.73-84.81; and OR 5.52, 95% CI 2.45-12.46), and use of ultrasound diagnostic techniques during pregnancy (OR 0.42, 95% CI 0.17-1.00).

CONCLUSIONS

Among non-genetic factors, those affecting the child during pregnancy are especially important because of their preventability.

Socio-economic characteristics in children with coeliac disease

AIM

To study the relationship between socio-economic factors and coeliac disease.

METHODS

This study was part of a prospective cohort study of 16 286 children born from 1 October 1997-1 October 1999 (the ABIS study; All Babies in Southeast Sweden). Eight paediatric departments recorded all children with coeliac disease in southeast Sweden. Coeliac disease was confirmed through biopsy. Socio-economic characteristics (maternal employment, civil status, whether parents were born in Sweden, parental education, place of living before pregnancy and during pregnancy, crowded living), infant sex, previous siblings, parental age and maternal alcohol consumption during pregnancy were analysed using logistic regression. All data, except for those related to diagnosis of coeliac disease, were obtained through a questionnaire distributed at birth.

RESULTS

Coeliac disease in the offspring was less common among mothers who had worked < 3 mo during pregnancy (odds ratio, OR = 0.29; 95% CI: 0.09-0.94; p = 0.039). This risk decrease remained after adjustment for confounders (adjusted OR = 0.28; 95% CI: 0.09-0.92; p = 0.035). No other socio-economic factor was related to coeliac disease.

CONCLUSION

This study indicates that most socio-economic factors are probably of little importance to the development of coeliac disease.

The Belgrade childhood diabetes study: prenatal and social associations for type 1 diabetes

The aim of this study was to investigate whether prenatal and social factors are associated with the development of type 1 diabetes. A case-control study was conducted in Belgrade during the period 1994-97. A total of 105 children </= 16 years old with recently onset of diabetes and 210 control children, individually matched by age (+/- 1 year), sex and place of residence, were included in the study. In the analysis using multivariable logistic regression, the following factors were significantly related to type 1 diabetes: poor socio-economic status (Odds ratio = 4.18, 95% confidence interval [2.01, 8.72]); higher education of father (1.53, [1.16, 2.03]); complications during pregnancy (3.39, [1.64, 7.00]); ultrasound scan during pregnancy (0.40, [0.20, 0.79]); gestational age > 41 weeks (11.11, [1.80, 68.52]); mother's consumption of foods containing nitrosamines during pregnancy (3.14, [1.68, 5.87]); and consumption of alcohol by father (4.54, [2.34, 8.79]).

Social disadvantage, family composition, and diabetes mellitus: prevalence and outcome

OBJECTIVE

To investigate the relation between social disadvantage and family composition on diabetes prevalence and diabetes care outcome.

DESIGN

Retrospective audit in the south west of England of 801 children with diabetes mellitus.

MAIN OUTCOME MEASURES

Prevalence of diabetes in relation to the Townsend index. Admissions to hospital with diabetes related problems, glycated haemoglobin, time spent in hospital, outpatient attendance rates.

RESULTS

There was no association between social status and diabetes prevalence. Social deprivation increased the likelihood of admission for hypoglycaemia. Children living with a single parent were more likely to be admitted to hospital with a diabetes related problem and stay in hospital longer. Having either a parent with diabetes or a single parent increased the rates of clinic non-attendance. No association was identified between medium term diabetes control and either social disadvantage or single parent status.

CONCLUSIONS

Social disadvantage has no effect on diabetes prevalence and little on diabetes outcome in childhood. Family structure and parental diabetes have adverse effects on some aspects of diabetes outcome.

Demographic and clinical features of diabetes mellitus in 1095 Yemeni patients

The ever-increasing incidence of diabetes mellitus is a cause for growing public health concern in both developed and developing countries. In this study, we aim to explore the special demographic and clinical features of diabetes, as seen in a large sample of Yemeni patients, and to compare these features with those reported in other countries. All patients referred to our diabetic clinic over a five-year period were investigated according to a standardized protocol. Data was collected and fed into a personal computer with a software statistical package for analysis. The relative frequencies of clinical classes of diabetes were 10.5% for IDD, 58.6% for non-obese NIDDM; 26.2% for obese NIDDM, and 4.7% for IGT. In the IDDM class, the age-specific relative frequency rate showed a higher and earlier onset peak frequency in females than in males. Among NIDDM class, about 31% of patients were diagnosed under the age of 45 years, and only 12% were first diagnosed after the age of 65 years. Most NIDDM patients came from social classes I and II (professionals and intermediate professionals) and most IDDM patients came from social class IIIM (skilled manual). A positive family history of diabetes among first-degree relatives of index patients was observed in 33.7% of IDDM patients, in 30% of non-obese NIDDM patients, in 39.2% of obese NIDDM patients and 32% of IGT patients. Female NIDDM patients had a significantly higher mean body mass index (BMI) than males (P<0.0001). Hypertension was recognized in 24.2% of the diabetic population aged 20 to A(3) 65 years. Large vessel disease (LVD) was observed in 28% of patients, small vessel disease (SVD) in 45%, and peripheral neuropathy in 40.7%. Inadequate glycemic control was noticed during follow-up in the majority of patients. Diabetes mellitus in Yemen, especially NIDDM, is characterized by an earlier age at onset, and predominance of males and non-obese NIDM subclass. Other characteristics include moderate genetic susceptibility, inadequate glycemic control and high prevalence of chronic complications.

Family characteristics and insulin dependent diabetes

During the calendar year of 1988 a survey of new cases of insulin dependent diabetes mellitus (IDDM) in children under the age of 15 years in the British Isles was conducted. After cases had been confirmed and permission obtained to contact the families, postal questionnaires were sent to the parents of children diagnosed in England, Wales, Northern Ireland, and the Republic of Ireland. Children who developed diabetes were significantly more likely to be heavier at birth in comparison with national reference data. The diabetic children were less likely to have been breast fed, and there were more children than expected whose fathers were in nonmanual occupations. Where there was a first degree relative with IDDM there were positive correlations between the age at diagnosis of the index cases and that of their diabetic fathers and their diabetic siblings, but not their diabetic mothers. A higher proportion of children than expected who were diagnosed under the age of 5 years had fathers with IDDM. Characteristics of family members associated with IDDM in children that might provide pointers to the aetiology of the disease include heavier birth weight, method of infant feeding, the age at onset of IDDM in affected fathers and affected siblings, and the family lifestyle as defined by social class of the father.

Insulin-dependent diabetes in a Scottish region: incidence and urban/rural differences

The incidence of insulin-dependent diabetes mellitus in the 0-18 year age group was studied in Tayside Region for the years 1980 to 1983. The mean annual rate of 21.7 per 100,000 is high in international terms and suggests that the rise in incidence observed in Scotland in the 1970s has continued. Urban and rural incidences were compared using postcodes. Rural rates were significantly (0.02 greater than p greater than 0.01) higher, due mainly to the difference in rates for the 0-9 age groups.