Christopher C Patterson1, Valma Harjutsalo2, Joachim Rosenbauer3, Andreas Neu4, Ondrej Cinek5, Torild Skrivarhaug6, Birgit Rami-Merhar7, Gyula Soltesz8, Jannet Svensson9, Roger C Parslow10, Conxa Castell11, Eugen J Schoenle12, Polly J Bingley13, Gisela Dahlquist14, Przemysława K Jarosz-Chobot15, Dalė Marčiulionytė16,17, Edna F Roche18, Ulrike Rothe19, Natasa Bratina20, Constantin Ionescu-Tirgoviste21, Ilse Weets22, Mirjana Kocova23, Valentino Cherubini24, Natasa Rojnic Putarek25, Carine E deBeaufort26, Mira Samardzic27, Anders Green28. 1. Centre for Public Health and UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK. c.patterson@qub.ac.uk. 2. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. 3. German Diabetes Center, Institute of Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 4. University Children's Hospital, Tübingen, Germany. 5. Department of Pediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia. 6. Division of Adolescent and Paediatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway. 7. Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. 8. Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary. 9. Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark. 10. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 11. Department of Health, Government of Catalonia, Barcelona, Spain. 12. Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland. 13. Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK. 14. Department of Clinical Sciences, Paediatrics, University of Umeå, Umeå, Sweden. 15. Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland. 16. Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania. 17. Institute of Microbiology and Virology, Lithuanian University of Health Sciences, Kaunas, Lithuania. 18. Department of Paediatrics, Tallaght University Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland. 19. Health Sciences/Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 20. Diabetes and Metabolic Diseases, University Children's Hospital, Department of Endocrinology, Ljubljana, Slovenia. 21. National Institute of Diabetes Nutrition and Metabolic Diseases, NC Paulescu, Bucharest, Romania. 22. Diabetes Research Center and Laboratory of Clinical Biology, Brussels Free University-Vrije Universiteit Brussel, University Hospital Brussels-Universitair Ziekenhuis Brussel, Brussels, Belgium. 23. Department of Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia. 24. Division of Paediatric Diabetes, Azienda University Hospital, Ancona, Italy. 25. Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia. 26. Department of Paediatric Diabetes and Endocrinology, University of Luxembourg, Luxembourg, Luxembourg. 27. Department of Endocrinology, Institute for Sick Children, Podgorica, Montenegro. 28. Odense Patient data Exploratory Network (OPEN), Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Abstract
AIMS/HYPOTHESIS: Against a background of a near-universally increasing incidence of childhood type 1 diabetes, recent reports from some countries suggest a slowing in this increase. Occasional reports also describe cyclical variations in incidence, with periodicities of between 4 and 6 years. METHODS: Age/sex-standardised incidence rates for the 0- to 14-year-old age group are reported for 26 European centres (representing 22 countries) that have registered newly diagnosed individuals in geographically defined regions for up to 25 years during the period 1989-2013. Poisson regression was used to estimate rates of increase and test for cyclical patterns. Joinpoint regression software was used to fit segmented log-linear relationships to incidence trends. RESULTS: Significant increases in incidence were noted in all but two small centres, with a maximum rate of increase of 6.6% per annum in a Polish centre. Several centres in high-incidence countries showed reducing rates of increase in more recent years. Despite this, a pooled analysis across all centres revealed a 3.4% (95% CI 2.8%, 3.9%) per annum increase in incidence rate, although there was some suggestion of a reduced rate of increase in the 2004-2008 period. Rates of increase were similar in boys and girls in the 0- to 4-year-old age group (3.7% and 3.7% per annum, respectively) and in the 5- to 9-year-old age group (3.4% and 3.7% per annum, respectively), but were higher in boys than girls in the 10- to 14-year-old age group (3.3% and 2.6% per annum, respectively). Significant 4 year periodicity was detected in four centres, with three centres showing that the most recent peak in fitted rates occurred in 2012. CONCLUSIONS/ INTERPRETATION: Despite reductions in the rate of increase in some high-risk countries, the pooled estimate across centres continues to show a 3.4% increase per annum in incidence rate, suggesting a doubling in incidence rate within approximately 20 years in Europe. Although four centres showed support for a cyclical pattern of incidence with a 4 year periodicity, no plausible explanation for this can be given.
AIMS/HYPOTHESIS: Against a background of a near-universally increasing incidence of childhood type 1 diabetes, recent reports from some countries suggest a slowing in this increase. Occasional reports also describe cyclical variations in incidence, with periodicities of between 4 and 6 years. METHODS: Age/sex-standardised incidence rates for the 0- to 14-year-old age group are reported for 26 European centres (representing 22 countries) that have registered newly diagnosed individuals in geographically defined regions for up to 25 years during the period 1989-2013. Poisson regression was used to estimate rates of increase and test for cyclical patterns. Joinpoint regression software was used to fit segmented log-linear relationships to incidence trends. RESULTS: Significant increases in incidence were noted in all but two small centres, with a maximum rate of increase of 6.6% per annum in a Polish centre. Several centres in high-incidence countries showed reducing rates of increase in more recent years. Despite this, a pooled analysis across all centres revealed a 3.4% (95% CI 2.8%, 3.9%) per annum increase in incidence rate, although there was some suggestion of a reduced rate of increase in the 2004-2008 period. Rates of increase were similar in boys and girls in the 0- to 4-year-old age group (3.7% and 3.7% per annum, respectively) and in the 5- to 9-year-old age group (3.4% and 3.7% per annum, respectively), but were higher in boys than girls in the 10- to 14-year-old age group (3.3% and 2.6% per annum, respectively). Significant 4 year periodicity was detected in four centres, with three centres showing that the most recent peak in fitted rates occurred in 2012. CONCLUSIONS/ INTERPRETATION: Despite reductions in the rate of increase in some high-risk countries, the pooled estimate across centres continues to show a 3.4% increase per annum in incidence rate, suggesting a doubling in incidence rate within approximately 20 years in Europe. Although four centres showed support for a cyclical pattern of incidence with a 4 year periodicity, no plausible explanation for this can be given.
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