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Sheehan A, Freni Sterrantino A, Fecht D, Elliott P, Hodgson S. Childhood type 1 diabetes: an environment-wide association study across England. Diabetologia 2020; 63:964-976. [PMID: 31980846 PMCID: PMC7145790 DOI: 10.1007/s00125-020-05087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes is an autoimmune disease affecting ~400,000 people across the UK. It is likely that environmental factors trigger the disease process in genetically susceptible individuals. We assessed the associations between a wide range of environmental factors and childhood type 1 diabetes incidence in England, using an agnostic, ecological environment-wide association study (EnWAS) approach, to generate hypotheses about environmental triggers. METHODS We undertook analyses at the local authority district (LAD) level using a national hospital episode statistics-based incident type 1 diabetes dataset comprising 13,948 individuals with diabetes aged 0-9 years over the period April 2000 to March 2011. We compiled LAD level estimates for a range of potential demographic and environmental risk factors including meteorological, land use and environmental pollution variables. The associations between type 1 diabetes incidence and risk factors were assessed via Poisson regression, disease mapping and ecological regression. RESULTS Case counts by LAD varied from 1 to 236 (median 33, interquartile range 24-46). Overall type 1 diabetes incidence was 21.2 (95% CI 20.9, 21.6) per 100,000 individuals. The EnWAS and disease mapping indicated that 15 out of 53 demographic and environmental risk factors were significantly associated with diabetes incidence, after adjusting for multiple testing. These included air pollutants (particulate matter, nitrogen dioxide, nitrogen oxides, carbon monoxide; all inversely associated), as well as lead in soil, radon, outdoor light at night, overcrowding, population density and ethnicity. Disease mapping revealed spatial heterogeneity in type 1 diabetes risk. The ecological regression found an association between type 1 diabetes and the living environment domain of the Index of Multiple Deprivation (RR 0.995; 95% credible interval [CrI] 0.991, 0.998) and radon potential class (RR 1.044; 95% CrI 1.015, 1.074). CONCLUSIONS/INTERPRETATION Our analysis identifies a range of demographic and environmental factors associated with type 1 diabetes in children in England.
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Affiliation(s)
- Annalisa Sheehan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anna Freni Sterrantino
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Daniela Fecht
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
- Imperial College NIHR Biomedical Research Centre, Imperial College London, London, UK
| | - Susan Hodgson
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
- UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK.
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Abstract
PURPOSE OF REVIEW Surveillance of type 1 diabetes provides an opportunity to address public health needs, inform etiological research, and plan health care services. We present issues in type 1 diabetes surveillance, review previous and current methods, and present new initiatives. RECENT FINDINGS Few diabetes surveillance systems distinguish between type 1 and type 2 diabetes. Most worldwide efforts have focused on registries and ages < 15 years, resulting in limited information among adults. Recently, surveillance includes use of electronic health information and national health surveys. However, distinguishing by diabetes type remains a challenge. Enhancing and improving surveillance of type 1 diabetes across all age groups could include validating questions for use in national health surveys. In addition, validated algorithms for classifying diabetes type in electronic health records could further improve surveillance efforts and close current gaps in our understanding of the epidemiology of type 1 diabetes.
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Affiliation(s)
- Sharon Saydah
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, 4770 Bufford Highway, MS F-75, Atlanta, GA, 30341, USA.
| | - Giuseppina Imperatore
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, 4770 Bufford Highway, MS F-75, Atlanta, GA, 30341, USA
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Goldacre RR. Associations between birthweight, gestational age at birth and subsequent type 1 diabetes in children under 12: a retrospective cohort study in England, 1998-2012. Diabetologia 2018; 61:616-625. [PMID: 29128935 PMCID: PMC6448964 DOI: 10.1007/s00125-017-4493-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS With genetics thought to explain only 40-50% of the total risk of type 1 diabetes, environmental risk factors in early life have been proposed. Previous findings from studies of type 1 diabetes incidence by birthweight and gestational age at birth have been inconsistent. This study aimed to investigate the relationships between birthweight, gestational age at birth and subsequent type 1 diabetes in England. METHODS Data were obtained from a population-based database comprising linked mother-infant pairs using English national Hospital Episode Statistics from 1998 to 2012. In total, 3,834,405 children, categorised by birthweight and gestational age at birth, were followed up through record linkage to compare their incidence of type 1 diabetes through calculation of multivariable-adjusted HRs. RESULTS Out of 3,834,405 children, 2969 had a subsequent hospital diagnosis of type 1 diabetes in childhood. Children born preterm (<37 weeks) or early term (37-38 weeks) experienced significantly higher incidence of type 1 diabetes than full term children (39-40 weeks) (HR 1.19 [95% CI 1.03, 1.38] and 1.27 [95% CI 1.16, 1.39], respectively). Children born at higher than average birthweight (3500-3999 g or 4000-5499 g) after controlling for gestational age experienced higher incidence of type 1 diabetes than children born at medium birthweight (3000-3499 g) (HR 1.13 [95% CI 1.03, 1.23] and 1.16 [95% CI 1.02, 1.31], respectively), while children at low birthweight (<2500 g) experienced lower incidence (0.81 [95% CI 0.67, 0.98]), signifying a statistically significant trend (p trend 0.001). CONCLUSIONS/INTERPRETATION High birthweight for gestational age and low gestational age at birth are both independently associated with subsequent type 1 diabetes. These findings help contextualise the debate about the potential role of gestational and early life environmental risk factors in the pathogenesis of type 1 diabetes, including the potential roles of insulin sensitivity and gut microbiota.
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Affiliation(s)
- Raphael R Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
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Joensen LE, Meldgaard Andersen M, Jensen S, Nørgaard K, Willaing I. The effect of peer support in adults with insulin pump-treated type 1 diabetes: a pilot study of a flexible and participatory intervention. Patient Prefer Adherence 2017; 11:1879-1890. [PMID: 29138541 PMCID: PMC5679694 DOI: 10.2147/ppa.s142204] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of this study was to explore the effects of a flexible and participatory peer support intervention in a clinical setting for adults with type 1 diabetes treated with an insulin pump, focusing on enhancing diabetes-specific social capital. The key questions were as follows: 1) what effects are appropriate to expect, according to participants? and 2) to what extent did these effects occur? METHODS Two peer support intervention programs were conducted in a diabetes specialist clinic (N=30). A participatory and adaptable approach allowed flexibility in the content of peer support meetings, which were facilitated by a diabetes nurse. Individual interviews explored participants' perception of effects of the intervention. Interview data were analyzed qualitatively. Participants (n=27) completed a baseline and postintervention questionnaire that included items assessing diabetes empowerment, diabetes distress, diabetes-specific social support, and diabetes loneliness. HbA1c levels were compared before and after the intervention. RESULTS Participants experienced enhanced diabetes-specific social capital, diabetes motivation, awareness of personal diabetes practices, and serenity and openness in life with diabetes. They also became more aware of treatment and support possibilities. Negative effects included feeling sad or upset after the meetings or feeling different than and not as well-controlled as other participants. Quantitative analyses showed enhanced social support, decreased eating distress and trends toward enhanced diabetes empowerment, decreased diabetes loneliness, and decreased diabetes distress (powerlessness). We found fewer positive and/or negative outcomes among participants who felt no need for peer support or felt that the group was not a unit or that important issues were not addressed. CONCLUSION The study indicated that flexible and participatory peer support can strengthen diabetes-specific social capital and improve participants' well-being and diabetes empowerment. Awareness of participants' incentives for attending peer support, as well as the risk of people feeling isolated within peer support groups, is essential to creating effective diabetes-specific social support.
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Affiliation(s)
- Lene Eide Joensen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte
| | | | - Sabrina Jensen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte
| | - Kirsten Nørgaard
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ingrid Willaing
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte
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Fortunato F, Cappelli MG, Vece MM, Caputi G, Delvecchio M, Prato R, Martinelli D, Workgroup ACODR. Incidence of Type 1 Diabetes among Children and Adolescents in Italy between 2009 and 2013: The Role of a Regional Childhood Diabetes Registry. J Diabetes Res 2016; 2016:7239692. [PMID: 27092312 PMCID: PMC4820582 DOI: 10.1155/2016/7239692] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/01/2016] [Accepted: 02/14/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Surveillance represents a key strategy to control type 1 diabetes mellitus (T1DM). In Italy, national data are missing. This study aimed at evaluating the incidence of T1DM in subjects <18 year olds in Apulia (a large southeastern region, about 4,000,000 inhabitants) and assessing the sensitivity of the regional Registry of Childhood-Onset Diabetes (RCOD) in the 2009-2013 period. METHODS We performed a retrospective study matching records from regional Hospital Discharge Registry (HDR), User Fee Exempt Registry (UFER), and Drugs Prescription Registry (DPR) and calculated T1DM incidence; completeness of each data source was also estimated. In order to assess the RCOD sensitivity we compared cases from the registry to those extracted from HDR-UFER-DPR matching. RESULTS During 2009-2013, a total of 917 cases (about 184/year) in at least one of the three sources and an annual incidence of 25.2 per 100,000 were recorded, lower in infant, increasing with age and peaked in 5- to 9-year-olds. The completeness of DPR was 78.7%, higher than that of UFER (64.3%) and of HDR (59.6%). The RCOD's sensitivity was 39.05% (360/922; 95% CI: 34.01%-44.09%). CONCLUSIONS Apulia appeared as a high-incidence region. A full, active involvement of physicians working in paediatric diabetes clinics would be desirable to improve the RCOD performance.
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Affiliation(s)
- F. Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 70121 Foggia, Italy
| | - M. G. Cappelli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 70121 Foggia, Italy
| | - M. M. Vece
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 70121 Foggia, Italy
| | - G. Caputi
- Taranto Local Health Unit, Viale Virgilio 31, Taranto, 74121 Puglia, Italy
| | - M. Delvecchio
- Pediatric Department “B. Trambusti”, Policlinico Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - R. Prato
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 70121 Foggia, Italy
| | - D. Martinelli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 70121 Foggia, Italy
- *D. Martinelli:
| | - Apulian Childhood-Onset Diabetes Registry Workgroup
- Pediatric Department, “Vito Fazzi” Hospital, Piazzetta Muratore, 73100 Lecce, Italy
- Pediatric Department, “F. Ferrari” Hospital, Via F. Ferrari 1, Casarano, 73042 Lecce, Italy
- Department of Biomedical Sciences and Human Oncology, Policlinico Hospital, Giovanni XXIII Children's Hospital, Via Amendola 207, 70126 Bari, Italy
- Pediatric Department, “Ospedali Riuniti” Policlinico Hospital, Viale Pinto 1, 70122 Foggia, Italy
- Pediatric Department, “Dario Camberlingo”Hospital, Viale M. delle Grazie, Francavilla Fontana, 72021 Brindisi, Italy
- Pediatric Department, “T. Maselli” Hospital, Viale 2 Giugno, San Severo, 71016 Foggia, Italy
- Pediatric Department, “Di Summa-Perrino” Hospital, S.S. 7 per Mesagne, 72100 Brindisi, Italy
- Pediatric Department, “G. Panico” Hospital, Via S. Pio X 4, Tricase, 73039 Lecce, Italy
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Policlinico Hospital, Giovanni XXIII Children's Hospital, Via Amendola 207, 70126 Bari, Italy
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Shiff NJ, Jama S, Boden C, Lix LM. Validation of administrative health data for the pediatric population: a scoping review. BMC Health Serv Res 2014; 14:236. [PMID: 24885035 PMCID: PMC4057929 DOI: 10.1186/1472-6963-14-236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this research was to perform a scoping review of published literature on the validity of administrative health data for ascertaining health conditions in the pediatric population (≤20 years). METHODS A comprehensive search of OVID Medline (1946 - present), CINAHL (1937 - present) and EMBASE (1947 - present) was conducted. Characteristics of validation studies that were abstracted included the study population, health condition, topic of the validation (e.g., single diagnosis code versus case-finding algorithm), administrative and validation data sources. Inter-rater agreement was measured using Cohen's κ. Extracted data were analyzed using descriptive statistics. RESULTS A total of 37 articles met the study inclusion criteria. Cohen's κ for study inclusion/exclusion and data abstraction was 0.88 and 0.97, respectively. Most studies validated administrative data from the USA (43.2%) and Canada (24.3%), and focused on inpatient records (67.6%). Case-finding algorithms (56.7%) were more frequently validated than diagnoses codes alone (37.8%). Five conditions were validated in more than one study: diabetes mellitus, inflammatory bowel disease, asthma, rotavirus infection, and tuberculosis. CONCLUSIONS This scoping review identified a number of gaps in the validation of administrative health data for pediatric populations, including limited investigation of outpatient populations and older pediatric age groups.
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Affiliation(s)
- Natalie J Shiff
- Department of Pediatrics, College of Medicine, University of Saskatchewan, 103 Hospital Drive, SK S7N 0W8, Saskatoon, Canada
| | - Sadia Jama
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 103 Hospital Drive, SK S7N 0W8, Saskatoon, Canada
| | - Catherine Boden
- University Library, University of Saskatchewan, Room 1441, Leslie and Irene Dube Health Sciences Library, 104 Clinic Place, SK S7N 5E5, Saskatoon, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, S113-750 Bannatyne Avenue, University of Manitoba, MB R3E 0W3, Winnipeg, Canada
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Sinha S, Peach G, Poloniecki JD, Thompson MM, Holt PJ. Studies using English administrative data (Hospital Episode Statistics) to assess health-care outcomes—systematic review and recommendations for reporting. Eur J Public Health 2012; 23:86-92. [DOI: 10.1093/eurpub/cks046] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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