International Journal of Epidemiology, Vol 26, 1307-1313, Copyright © 1997 by International Epidemiological Association
A Staines, HJ Bodansky, PA McKinney, FE Alexander, RJ McNally, GR Law, HE Lilley, C Stephenson and RA Cartwright
BACKGROUND: The incidence of insulin-dependent diabetes mellitus (IDDM)
incidence varies between and within countries. The origins of this
variation are disputed, but they involve both genetic and non-genetic
influences. To explore the role of environmental factors in the aetiology
of IDDM we have examined the incidence in small geographical areas and
related it to variables derived from national censuses. METHODS: This is an
ecological analysis of incidence data from a register of children with IDDM
covering the counties of West Yorkshire, North Yorkshire and Humberside in
the north of England. All children aged < or = 16, diagnosed with IDDM
between 1978 and 1990 were eligible for inclusion. Spatial variation in
incidence between electoral wards was investigated using Poisson
regression, in relation to socioeconomic status, population density,
urban-rural status and measures of geographical isolation. Ward child
populations varied in size from 84 to 7197 (mean = 1545). RESULTS: Rates
were significantly lower in wards of high population density and with many
overcrowded houses. The rate ratio for areas in the upper half of the
childhood density distribution was 0.88 (95% confidence interval (CI):
0.78-0.99) and for the two upper tertiles of household overcrowding the
rate ratios were 0.84 (95% CI: 0.74-0.95) and 0.68 (95% CI: 0.58-0.79)
respectively. CONCLUSIONS: The incidence of childhood IDDM was associated
with environmental factors including population density and overcrowded
homes. A possible inference from these data is that patterns of infection
are involved in the occurrence of IDDM. Analytical epidemiological studies
will be needed to investigate these ideas further.
ARTICLES
Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density
Division of Public Health, Nuffield Institute for Health, Leeds, UK.
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