Spatial epidemiology of diabetes in the SEARCH for Diabetes in Youth Study

描述(申请人提供)：糖尿病是儿童和青少年的主要慢性病之一，发病率在全球范围内呈上升趋势。糖尿病发病率的空间或地理差异是所有非传染性疾病中观察到的最大差异之一。人们对美国境内的地理差异知之甚少。过去，儿科糖尿病主要被认为是1型糖尿病，而儿科2型糖尿病(非自身免疫性和非胰岛素依赖型)最近出现了。青年糖尿病研究始于2000年，目的是按年龄、性别、种族/民族和糖尿病类型估计美国20岁以下不同种族青年的糖尿病患病率和发病率。这项附属研究旨在(1)描述和绘制儿科糖尿病发病的空间分布，包括来自南卡罗来纳州、俄亥俄州、科罗拉多州和华盛顿州的种族和地理多样性搜索人群中的1型和2型糖尿病；(2)在一系列统计、生态分析中评估1型和2型糖尿病的发病率与地理和邻里特征(地理位置、城市化、人口密度、社会经济特征)的关系；(3)在结合搜索数据和搜索病例对照研究的多水平分析中，一旦确定了个人水平的风险因素，则探索聚集的地理和邻里特征对类型1或类型2的风险的影响程度。这一努力可能为随后的儿童糖尿病病因学研究提供新的线索，并将帮助卫生保健规划者确定特别需要卫生服务资源的地理区域。

DESCRIPTION (provided by applicant): Diabetes mellitus is one of the leading chronic diseases of childhood and adolescence, and incidence is increasing worldwide. The spatial or geographic variation in incidence of diabetes is one of the largest observed for any non-communicable disease. Very little is known about geographic variation within the United States. While in the past pediatric diabetes has been thought of largely as Type 1, pediatric Type 2 diabetes (non-autoimmune and non-insulin-dependent) has recently emerged. The SEARCH for Diabetes in Youth Study was initiated in 2000 to estimate population prevalence and incidence of diabetes in ethnically- diverse youth under the age of 20 years in the United States by age, gender, race/ethnicity, and diabetes type. This ancillary study to SEARCH aims to (1) describe and map the spatial distribution of incident pediatric diabetes, including Type 1 and Type 2 in the ethnically and geographically diverse SEARCH populations from South Carolina, Ohio, Colorado, and Washington; (2) evaluate the association of incidence of Type 1 and Type 2 diabetes with geographic and neighborhood characteristics (location, urbanization, population density, socio-economic characteristics) in a series of statistical, ecologic analyses; (3) to explore the extent to which aggregate geographical and neighborhood characteristics influence risk of Type 1 or Type 2, once established individual-level risk factors are taken into account, in a multi-level analysis combining data from SEARCH with the SEARCH Case Control study. This effort may provide novel leads for subsequent etiologic studies of pediatric diabetes and will assist health care planners in identifying geographic areas in particular need of health services resources.