Socioeconomic conditions and type 1 diabetes in childhood in North Rhine–Westphalia, Germany

Abstract

Aims/hypothesis The aim of the study was to investigate the relationships between childhood type 1 diabetes and socioeconomic conditions, which might provide clues to the aetiology of the disease. Materials and methodsIn an ecological study, we investigated the relationships between socioeconomic conditions and the incidence of type 1 diabetes incidence among children aged 0-14 years in North Rhine-Westphalia (NRW), Germany, between 1996 and 2000 at the level of the 33 districts. Incidence data were obtained from the population-based NRW diabetes register and regional socioeconomic data from official statistics. Associations were assessed by Poisson regression models and Bayesian conditionally autoregressive regression models (CAR). Results In simple Poisson regression, population density, proportion of non-German nationals in the population, measures of income, education and professional training, and deprivation scores were significantly associated with diabetes risk (p<0.01). An increase of about one interquartile range (IQR) in population density, proportion of non-German nationals or household income was associated with a 9-12% decrease in diabetes incidence. A rise of about one IQR in income ratio, measures of education and professional training, or in deprivation score (high values correspond to high deprivation) was associated with an 8-12% incidence increase. There was a significantly 'linear' increasing incidence trend across five deprivation classes (relative risk: 1.06; 95% CI: 1.03-1.09). All associations were confirmed when overdispersion and spatial autocorrelation were accounted for in Poisson and CAR models. Conclusions/interpretationsThe results raise the possibility that the risk for type 1 diabetes is higher for children living in socially deprived and less densely populated areas. Subsequent investigations are necessary to verify the observed ecological relations at the individual level and to identify the causal factors behind the socioeconomic indicators. Diabetologia (2007) 50:720-728

Stress in childhood and the risk of type 1 diabetes

“…The parents' educational level was in our study associated with diabetes risk, where the combination of a lowly educated mother and a highly educated father increased the risk of T1D (Papers 2 and 3), which is partly in line with previous findings linking low maternal education to diabetes risk (Blom et al, 1989;Du Prel et al, 2007;Soltész et al, 1994). Low educational level is often regarded a stressor and an indicator of adverse living conditions and low social status (see introduction).…”

Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies

“…However, as this meta-analysis was based upon observational studies, it is impossible to rule out the influence of unrecorded confounders, although any such confounder would have to operate similarly across all studies. Social class is a possibility, as it may be associated with the likelihood of delivery by Caesarean section, but as the association between social class and type 1 diabetes is inconsistent [24,[44][45][46] it seems unlikely that it could exert the necessary confounding influence. Gestational diabetes is another possibility, but the proportion of mothers with gestational diabetes in these European populations is likely to be small [47], reducing the likelihood of marked confounding, and adjustment for gestational diabetes in seven of the studies [15,25,27] revealed little evidence of confounding.…”

Long-term detrimental consequences of the onset of type 1 diabetes on annual earnings—evidence from annual registry data in 1990–2005

“…However, a potential weakness in the study design was the assumption of no differences prior to onset of diabetes, as two studies have pointed to a possible association between socioeconomic status and the incidence of childhood onset of type 1 diabetes [36,37]. Parental human capital is also associated with their children's labour-market outcomes [13,14], and crude comparisons would then overstate the pure diabetes-related effect on earnings.…”