Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25year period 1989-2013: a multicentre prospective registration study
Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25year period 1989-2013: a multicentre prospective registration study
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DOI：
10.1007/s00125-018-4763-3
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发表时间：
2019-03-01
期刊：
影响因子：
8.2
通讯作者：
Green, Anders
中科院分区：
文献类型：
--
作者：
Patterson, Christopher C.;Harjutsalo, Valma;Green, Anders
目的/假设在儿童1型糖尿病发病率几乎普遍增加的背景下，一些国家最近的报告表明这种增加有所减缓。偶尔的报告也描述了发病率的周期性变化，周期在4和6years.Methods0 - 14岁年龄组的年龄/性别标准化的发病率报告了26个欧洲中心（代表22个国家），在地理定义的地区登记了新诊断的个人长达25年，在1989年至2013年期间。Poisson回归用于估计增加率并检验周期性模式。Joinpoint回归软件被用来拟合分段对数线性关系的发病率trends. Results显着增加，但在所有两个小中心，最大的增长率为6.6%，每年在波兰中心。高发病率国家的几个中心近年来的增长率有所下降。尽管如此，所有中心的汇总分析显示，发病率每年增加3.4%（95% CI 2.8%，3.9%），尽管有一些迹象表明2004-2008年期间的增长率降低。在0至4岁年龄组（每年分别为3.7%和3.7%）和5至9岁年龄组（每年分别为3.4%和3.7%），男孩和女孩的增长率相似，但在10至14岁年龄组，男孩的增长率高于女孩（每年分别为3.3%和2.6%）。在4个中心检测到显著的4年周期性，其中3个中心显示拟合率的最近峰值发生在2012年。结论/解释尽管一些高风险国家的增长率降低，但各中心的汇总估计值继续显示发病率每年增加3.4%，这表明欧洲的发病率在大约20年内翻了一番。尽管4个中心显示支持4年周期的周期性发病模式，但无法给出合理的解释。
Aims/hypothesisAgainst 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 6years.MethodsAge/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 25years 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.ResultsSignificant 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 4year periodicity was detected in four centres, with three centres showing that the most recent peak in fitted rates occurred in 2012.Conclusions/interpretationDespite 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 20years in Europe. Although four centres showed support for a cyclical pattern of incidence with a 4year periodicity, no plausible explanation for this can be given.