Lévy-Marchal C
INSERM U457, Hôpital Robert-Debré, Paris.
Rev Epidemiol Sante Publique. 1998 Jun;46(3):157-63.
The aim of the study was to analyze secular trends for increase of annual incidence rates of childhood insulin-dependent diabetes in France between 1988 and 1995.
The French Registry of incidence of insulin-dependent diabetes in childhood was set up in 1988 in four regions covering more than 2 million subjects aged less than 20 yr. The degree of ascertainment was calculated as 96% between 1988-1995 using data from the prospective catchment of the cases and medical data from the French Social Security.
Standardized annual incidence rates were 7.17 and 9.28 per 100,000, in 1988 and 1995 respectively, assessing a 29% increase for age range at diagnosis 0-19 yr. The trend for increase was statistically significant (r' = 0.95; p = 0.01). The incremental trend of incidence rates was calculated as 0.039 per year following a linear model for increase which proved to predict calculated values not significantly different from observed values for annual total numbers of cases. This increase affected equally both genders, and the younger age group at diagnosis (between 0 and 14 yr.), but not the group 15-19 yr. of age at diagnosis.
The increase in incidence of IDDM was at the same order of magnitude as observed in Nordic countries where the overall incidence rate of IDDM in childhood is at least three times as high as in France. It points towards environmental factors playing a major role in the auto-immune process leading to beta cell destruction. This observation also strengthens the need for research programs on the prevention of the clinical phase of the disease. Such an observation should also supply Health Care providers with important information for future management and organization of IDDM care in childhood.
本研究旨在分析1988年至1995年间法国儿童胰岛素依赖型糖尿病年发病率上升的长期趋势。
1988年在四个地区建立了法国儿童胰岛素依赖型糖尿病发病率登记处，覆盖超过200万20岁以下的人群。利用病例前瞻性收集的数据和法国社会保障的医疗数据，计算出1988 - 1995年间的确诊率为96%。
1988年和1995年的标准化年发病率分别为每10万人7.17例和9.28例，0 - 19岁诊断年龄范围的发病率上升了29%。上升趋势具有统计学意义（r' = 0.95；p = 0.01）。按照线性增长模型计算，发病率的递增趋势为每年0.039，这一模型预测的年度病例总数计算值与观察值无显著差异。这种上升对男女两性以及诊断时年龄较小的组（0至14岁）均有同等影响，但对诊断时年龄在15 - 19岁的组没有影响。
IDDM发病率的上升幅度与北欧国家观察到的情况相同，在北欧国家儿童IDDM的总体发病率至少是法国的三倍。这表明环境因素在导致β细胞破坏的自身免疫过程中起主要作用。这一观察结果也强化了对该疾病临床阶段预防研究项目的需求。这样的观察结果也应为医疗保健提供者在儿童IDDM护理的未来管理和组织方面提供重要信息。
