Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies
复制标题
DOI：
10.1093/ije/dyq207
复制
发表时间：
2011-04-01
影响因子：
7.7
通讯作者：
Patterson, Chris C.
中科院分区：
文献类型：
--
作者：
Cardwell, Chris R.;Stene, Lars C.;Patterson, Chris C.
背景 儿童期 1 型糖尿病的发病率在全球范围内几乎普遍上升，但该疾病的病因仍然很大程度上未知。我们通过对之前的研究进行汇总分析，调查了出生顺序是否与儿童糖尿病风险相关。方法从 MEDLINE、Web of Science 和 EMBASE 中识别出 2010 年 1 月之前发表的相关研究。研究作者提供了个体患者数据或进行了预先指定的分析。采用荟萃分析技术得出混杂因素调整前后的综合比值比 (OR)，并调查异质性。 结果 提供了 6 个队列研究和 25 个病例对照研究的数据，包括 11 955 例 1 型糖尿病病例。总体而言，在调整混杂因素之前没有证据表明存在关联。调整母亲出生年龄和其他混杂因素后，第二胎或以后出生的孩子患糖尿病的风险明显降低[完全调整 OR = 0.90 95% 置信区间 (CI) 0.83-0.98；完全调整 OR = 0.90 95% 置信区间 (CI) 0.83-0.98； P = 0.02] 但这种关联在研究之间存在显着差异 (I-2 = 67%)。先验亚组分析显示，5 岁以下儿童中的相关性更强且更一致（n = 25 项研究，母亲年龄调整 OR = 0.84 95% CI 0.75, 0.93；I-2 = 23%）。结论 尽管研究之间的相关性有所不同，但有一些证据表明，随着出生顺序的增加，儿童发病 1 型糖尿病的风险较低，特别是在 < 5 岁的儿童中。这一发现可能反映了后来出生的孩子在生命早期接触感染的机会增加。
Background The incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.Methods Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity.Results Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second- or later born children became apparent [fully adjusted OR = 0.90 95% confidence interval (CI) 0.83-0.98; P = 0.02] but this association varied markedly between studies (I-2 = 67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children < 5 years of age (n = 25 studies, maternal age adjusted OR = 0.84 95% CI 0.75, 0.93; I-2 = 23%).Conclusion Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged < 5 years. This finding could reflect increased exposure to infections in early life in later born children.