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Research Article| Volume 56, ISSUE 3, P269-273, March 2003

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Small area variation in childhood diabetes mellitus in Austria: links to population density, 1989 to 1999

  • Edith Schober
    Correspondence
    Corresponding author. Universitätsklinik f Kinder–und Jugendheilkunde, Währingergürtel 18–20, A 1090 Wien, Austria. Tel.: ++43-1-40400-3232; fax: ++43-1-40400-3238.
    Affiliations
    Department of Pediatrics, University of Vienna, Waehringerguertel 18–20, A-1090 Vienna, Austria
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  • Birgit Rami
    Affiliations
    Department of Pediatrics, University of Vienna, Waehringerguertel 18–20, A-1090 Vienna, Austria
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  • Thomas Waldhoer
    Affiliations
    Department of Epidemiology, Institute of Cancer Research, University of Vienna, Borschkegasse 6, A-1090 Vienna, Austria
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  • for the Austrian Diabetes Incidence Study Group

      Abstract

      We analyzed the associations of environmental factors with the regional distribution of Type 1 diabetes mellitus in Austria. All newly diagnosed cases (n = 1449) from 1989 to 1999 were allocated to districts using the postal code. Nitrate content of the water was measured by the Austrian Federal Environmental Agency. Data on infant mortality, population density, and percentage of employment by industry were derived from Statistics Austria. An inverse effect was seen between the proportion of children younger than 15 years of age and the risk ratio (P<.01). Infant mortality, population density, and percentage of persons with employment in industry were not of significant influence. The mean nitrate level was positively associated (P = .07). In regions with a higher percentage of children younger than 15 years of age, fewer children developed diabetes, which is in agreement with the observation that early social mixing is a protective factor. Nitrate levels may have a confounding effect.

      Keywords

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      References

        • EURODIAB ACE Study Group
        Variation and trends in incidence of childhood diabetes in Europe.
        Lancet. 2000; 355: 873-876
        • Karvonen M.
        • Viik-Kajander M.
        • Moltchanova E.
        • et al.
        Incidence of childhood Type 1 diabetes worldwide.
        Diabetes Care. 2000; 23: 1516-1526
        • Waldhör T.
        • Schober E.
        • Karimian-Theherani D.
        • et al.
        Regional differences and temporal incidence trend of Type 1 diabetes mellitus in Austria from 1989 to 1999: a nationwide study.
        Diabetologia. 2000; 43: 1449-1450
        • Schober E.
        • Schneider U.
        • Waldhör T.h.
        • et al.
        Increasing incidence of IDDM in Austrian children: a nationwide study.
        Diabetes Care. 1995; 18: 1280-1283
      1. Erhebung der Wassergüte in Österreich gemäß Hydrographiegesetz i.d.F. des BGB1.Nr. 252/90; WWK/BMLF, Ämter der Landesregierungen. Datenbereitstellung durch Umweltbundesamt GmbH Wien 1998.

        • Besag J.
        • York J.
        • Mollie A.
        Bayesian image restoration, with applications in spatial statistics.
        Ann Statist Math. 1991; 43: 1-59
        • Bernardinelli L.
        • Clayton D.
        • Montomoli C.
        Bayesian estimates of disease maps: how important are priors?.
        Stat Med. 1995; 14: 2411-2431
        • Spiegelhalter D.
        • Thomas A.
        • Best N.
        Winbugs, version 1.3: user manual. MRC Biostatistics Unit, Cambridge (UK)2000
        • Smith B.
        Bayesian Output Analysis program. The University of Iowa College of Public Health, Iowa City1999
        • Assuncao R.M.
        • Reis E.A.
        A new proposal to adjust Moran's I for population density.
        Stat Med. 1999; 18: 2147-2162
        • Marshall R.J.
        Mapping disease and mortality rates using Empirical Bayes Estimators.
        Appl Statist. 1991; 40: 283-294
      2. 4th edition. SAS/STAT User's Guide. Version 6. vol. 2. SAS Institute Inc, Cary (NC)1989
        • Inorganic constituents and physical parameters
        Guidelines for drinking water quality.
        in: 2nd edition. health criteria and other supporting information. vol. 2. World Health Organization, Geneva1996: 313-324
      3. European Union Council Directive on Quality of Water for Human Consumption no. 98/83. European Union, Brussels1998
        • Dahlquist G.
        • Blom G.
        • Person L.S.
        • et al.
        Dietary factors and the risk of developing insulin dependent diabetes in childhood.
        BMJ. 1990; 300: 1302-1306
        • Virtanen S.M.
        • Jaakola L.
        • Räsänen L.
        • et al.
        Nitrate and nitrate intake and the risk for type I diabetes in Finnish children.
        Diabet Med. 1994; 11: 656-662
        • Kostraba J.N.
        • Gay E.C.
        • Rewers M.
        • et al.
        Nitrate levels in community drinking waters and risk of IDDM: an ecological analysis.
        Diabetes Care. 1992; 15: 1505-1508
        • Parslow R.C.
        • McKinney P.A.
        • Law G.R.
        • et al.
        Incidence of childhood diabetes mellitus in Yorkshire, northern England, is associated with nitrate in drinking water: an ecological analysis.
        Diabetologia. 1997; 40: 550-556
        • Van Maanen J.M.S.
        • Albering H.J.
        • de Kok T.M.C.M.
        • et al.
        Does the risk of childhood diabetes mellitus require revision of the guideline values for nitrate in drinking water?.
        Environ Health Perspect. 2000; 108: 457-461
        • Patterson C.C.
        • Carson D.J.
        • Hadden D.R.
        • Northern Ireland Diabetes Study Group
        Epidemiology of childhood IDDM in Northern Ireland 1989–1994: low incidence in areas with highest population density and most household crowding.
        Diabetologia. 1996; 39: 1063-1069
        • Staines A.
        • Bodansky H.J.
        • McKinney P.A.
        • et al.
        Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density.
        Int J Epidemiol. 1997; 26: 1307-1313
        • Cherubini V.
        • Carle E.
        • Gesuita R.
        • et al.
        Large incidence variation of Type I diabetes in central-southern Italy 1990–1995: lower risk in rural areas.
        Diabetologia. 1999; 42: 789-792
        • Schoenle E.J.
        • Semadeni S.
        • Molinari L.
        • et al.
        Epidemiology of IDDM in Switzerland: increasing incidence and rural-urban differences in Swiss men born 1948–72.
        Diabetes Care. 1994; 17: 955-960
        • Morales-Perez F.M.
        • Baquero-Romero J.
        • Perez-Miranda M.
        Incidence of type I diabetes among children and young adults (0–29 years) in the province of Badajoz, Spain during 1992 to 1996.
        Acta Paediatr. 2000; 89: 101-104
        • Muntoni S.
        • Cocco P.
        • Aru G.
        • et al.
        Nutritional factors and worldwide incidence of childhood type 1 diabetes.
        Am J Clin Nutr. 2000; 71: 1525-1529
        • Neu A.
        • Kehrer M.
        • Hub R.
        • et al.
        Incidence of IDDM in German children aged 0–14 years: a 6-year population-based study (1987–1993).
        Diabetes Care. 1997; 20: 530-533
        • Patterson C.C.
        • Waugh N.R.
        Urban/rural and deprivational differences in incidence and clustering of childhood diabetes in Scotland.
        Int J Epidemiol. 1992; 21: 108-117
        • Verge C.F.
        • Howard N.J.
        • Irwig L.
        • et al.
        Environmental factors in childhood IDDM: a population based control study.
        Diabetes Care. 1994; 17: 1381-1389
        • Rami B.
        • Schneider U.
        • Imhof A.
        • et al.
        Risk factors for type 1 diabetes mellitus in children in Austria.
        Eur J Pediatr. 1999; 158: 362-366
        • Waldhör T.
        • Schober E.
        • Rami B.
        • et al.
        The prevalence of IDDM in the first degree relatives of children newly diagnosed with IDDM in Austria: a population based study.
        Exp Clin Endocrinol Diabetes. 1999; 107: 323-327