Thomas Waldhoer, Birgit Rami, Edith Schober
Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
Eur J Epidemiol. 2008;23(3):213-8. doi: 10.1007/s10654-008-9223-9. Epub 2008 Jan 18.
We investigated whether the significant spatial West/East trend of incidence of Diabetes mellitus Type 1 in Austrian children changed between 1989 and 2005. Additionally we tested, whether population density and mean body mass index of newborns is associated with incidence.
All newly diagnosed cases aged 0-14 years in Austria (n = 2644), prospectively registered from 1989 to 2005 were allocated to 99 districts. Ecological regression and analysis was done by Bayesian hierarchical models including spatially correlated risks.
In Austria, the incidence rose from 9.1/100.000 in 1989--1994 to 14.9/100.000 in 2001--2005. The spatial trend in the period 1989--1995, showing high incidence in the Eastern parts of Austria, disappeared. In the period 2001--2005 a significant inverse negative association of population density with incidence was found. Mean body mass index of newborns in the Austrian population is significantly positively associated with incidence.
The observation of higher incidence in rural areas in Austria during recent years may reflect a lower exposure to protective environmental factors, e.g. infections early in life. The observed association with the BMI in newborns indicates that neonatal or prenatal metabolic aspects may modulate the risk for childhood diabetes. We cannot explain the change in the spatial distribution of incidence.
我们调查了1989年至2005年间奥地利儿童1型糖尿病发病率显著的西/东空间趋势是否发生了变化。此外，我们还测试了人口密度和新生儿平均体重指数是否与发病率相关。
对1989年至2005年期间在奥地利前瞻性登记的所有新诊断的0至14岁病例（n = 2644）分配到99个地区。采用贝叶斯分层模型进行生态回归分析，包括空间相关风险。
在奥地利，发病率从1989 - 1994年的9.1/100000上升到2001 - 2005年的14.9/100000。1989 - 1995年期间奥地利东部发病率较高的空间趋势消失了。在2001 - 2005年期间，发现人口密度与发病率呈显著的负相关。奥地利人群中新生儿的平均体重指数与发病率呈显著正相关。
近年来奥地利农村地区发病率较高的观察结果可能反映出接触保护性环境因素较少，例如生命早期的感染。观察到的与新生儿体重指数的关联表明，新生儿期或产前的代谢因素可能会调节儿童患糖尿病的风险。我们无法解释发病率空间分布的变化。
