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Parental country of birth is a major determinant of childhood type 1 diabetes in Sweden
Natl Board Hlth & Welf, Ctr Epidemiol, Stockholm, Sweden; Uppsala Univ, Dept Childrens & Womens Hlth, Uppsala, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2008 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 9, no 1, p. 35-39Article in journal (Refereed) Published
Abstract [en]

Objective: To test the hypothesis that the risk of childhood diabetes type 1 increases with migration from a low to a high incidence region.

Methods: Register study of a national cohort of 783 547 children born between 1987 and 1993 who remained in Sweden in 2002, including 3225 children with childhood type 1 diabetes identified in hospital discharge data. Logistic regression analysis was used to test the hypotheses.

Results: Offspring of two parents born in very low (Asia excluding Middle East and Latin America) and low (southern and eastern Europe and the Middle East) incidence regions had the lowest adjusted odds ratios (ORs) of childhood type 1 diabetes; 0.21 (0.11-0.41) and 0.37 (0.29-0.48), respectively, compared with the Swedish majority population. When one parent was born in a low incidence country and one parent was Swedish born, the adjusted ORs increased but remained lower than the Swedish majority population.

Conclusions: Parental country of birth is an important determinant of childhood type 1 in Sweden. Heritable factors seem most likely to explain this pattern.

Place, publisher, year, edition, pages
Blackwell Munksgaard, 2008. Vol. 9, no 1, p. 35-39
Keywords [en]
Diabetes type 1
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-32940DOI: 10.1111/j.1399-5448.2007.00267.xISI: 000255130200006OAI: oai:DiVA.org:oru-32940DiVA, id: diva2:683746
Projects
Type 1 diabetes in children with non-Swedish background – epidemiology and clinical outcomeAvailable from: 2014-01-06 Created: 2014-01-06 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Type 1 diabetes in children with non-Swedish background: epidemiology and clinical outcome
Open this publication in new window or tab >>Type 1 diabetes in children with non-Swedish background: epidemiology and clinical outcome
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sweden holds third place of diabetes incidence in young people after Finland and Sardinia. One fifth of the population is nowadays of foreign descent. We have a substantial number of immigrants from countries where the risk for T1D is considerably lower. Migration as a natural experiment is a concept to assess the risk for diabetes in offspring of immigrant parents and assess the interaction between genetics (genotype) and the impact of environment (phenotype).

Aims: To study the risk of incurring diabetes for children of immigrant parents living in Sweden (I) and further study the risk if the child is born in Sweden or not (II); to specifically study and evaluate if children from East Africa have increased risk to develop T1D (III). To investigate if clinical and sociodemographic status at T1D onset differs between immigrant children compared to their Swedish indigenous peers (IV). Finally to study the clinical outcome and the impact of socio-demographic factors at diabetes onset after three years of treatment (V).

Methods: All five studies are observational, nationwide and population based, on prospectively collected data. Statistics mainly by logistic and linear regressions.

Results: Parental country of origin is a strong determinant for diabetes in the offspring. Children born to immigrant parents seem to keep their low risk compared to their Swedish peers (I). When adding the factor of being born in Sweden, the pattern changed; there was a significantly (p < 0.001) increased risk for T1D if the child was born in Sweden (II). East Africans have a substantial risk for T1D and especially if the children are born in Sweden (III). Immigrant children and adolescents have worse metabolic start at T1D onset compared to their indigenous Swedish peers (IV). After 3 years of treatment, the immigrant children had a sustained higher median HbA1c, compared to their Swedish peers (V).

Conclusions: Genotype and influences during fetal life or early infancy have an important impact for the risk of T1D pointing towards epigenetics playing a substantial role. Children with an origin in East Africa have a high risk of incurring T1D. Immigrant children have worse metabolic start at T1D onset, which sustains after three years of treatment

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2014. p. 59
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 102
Keywords
Type 1 diabetes, HbA1c, children, adolescents, ethnicity, epidemiology, immigration, adoption, socio-demographic, registers
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32843 (URN)978-91-7529-010-2 (ISBN)
Public defence
2013-04-11, Hörsal C2, Campus USÖ, Universitetssjukhuset, S Grev Rosengatan, 701 85 Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-01-31 Created: 2013-12-19 Last updated: 2017-10-17Bibliographically approved

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