Parental socio-economic position and the risk of type 1 diabetes in children and young adults in Denmark: A nation-wide register-based study

Abstract

Aim:

Diabetes mellitus type 1 is one of the most common serious chronic diseases in childhood and the incidence is increasing. Insight into risk factors may inform our etiologic understanding of the disease and subsequent prevention. Any socio-economic gradient in disease risk indicates a potential for prevention, since this points towards socially patterned environmental risk factors. The aim of this study was to investigate the association between measures of parental socio-economic position and the onset of type 1 diabetes in offspring based on individual data in the entire Danish population.

Methods:

In a study population of all children born in Denmark between 1 January 1987 and 31 December 2010, we examined the association between parental socio-economic position and the risk of type 1 diabetes up to the age of 25 years. The risk of type 1 diabetes was estimated according to maternal education, paternal education and household income using Cox proportional hazards regression, with adjustments for the a priori selected confounding variables: year of birth, maternal age at birth and parental type 1 diabetes.

Results:

In the study population of 1,433,584 children, a total of 4610 developed type 1 diabetes. We found no clear pattern in type 1 diabetes risk according to parental educational attainment or parental household income.

Conclusions:

In this large population covering study of the risk of type 1 diabetes according to individual-level parental socio-economic position, we found no strong indication of a socially patterned disease risk.

Keywords

Children epidemiology socio-economic status type 1 diabetes

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References

Patterson

Guariguata

Dahlquist

, et al. Diabetes in the young – a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract 2014;103:161–75.

Patterson

Harjutsalo

Rosenbauer

, et al. Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989-2013: a multicentre prospective registration study. Diabetologia. 2019;62(3):408-417.

Patterson

Karuranga

Salpea

, et al. Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019;157:107842.

Nathan

Genuth

Lachin

, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–86.

Atkinson

Eisenbarth

Michels

. Type 1 diabetes. Lancet 2014;383:69–82.

Nielsen

Ovesen

Mortensen

, et al. Type 1 diabetes, quality of life, occupational status and education level – a comparative population-based study. Diabetes Res Clin Pract 2016;121:62–8.

Aalto

Uutela

Kangas

. Health behaviour, social integration, perceived health and dysfunction. A comparison between patients with type I and II diabetes and controls. Scand J Soc Med 1996;24:272–81.

Atkinson

Eisenbarth

. Type 1 diabetes: new perspectives on disease pathogenesis and treatment. Lancet 2001;358:221–9.

Hyttinen

Kaprio

Kinnunen

, et al. Genetic liability of type 1 diabetes and the onset age among 22,650 young Finnish twin pairs: a nationwide follow-up study. Diabetes 2003;52:1052–5.

10.

Cardwell

Stene

Joner

, et al. Maternal age at birth and childhood type 1 diabetes: a pooled analysis of 30 observational studies. Diabetes 2010;59:486–94.

11.

Hussen

Persson

Moradi

. Maternal overweight and obesity are associated with increased risk of type 1 diabetes in offspring of parents without diabetes regardless of ethnicity. Diabetologia 2015;58:1464–73.

12.

Magnus

Olsen

Granstrom

, et al. Paternal and maternal obesity but not gestational weight gain is associated with type 1 diabetes. Int J Epidemiol 2018;47:417–26.

13.

Mackenbach

Stirbu

Roskam

, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008;358:2468–81.

14.

Bronnum-Hansen

. Socially disparate trends in lifespan variation: a trend study on income and mortality based on nationwide Danish register data. BMJ Open 2017;7:e014489.

15.

Puett

Lamichhane

Nichols

, et al. Neighborhood context and incidence of type 1 diabetes: the SEARCH for Diabetes in Youth study. Health & Place 2012;18:911–16.

16.

Liese

Puett

Lamichhane

, et al. Neighborhood level risk factors for type 1 diabetes in youth: the SEARCH case-control study. Int J Health Geogr 2012;11:1.

17.

Torres-Aviles

Carrasco

Icaza

, et al. Clustering of cases of type 1 diabetes in high socioeconomic communes in Santiago de Chile: spatio-temporal and geographical analysis. Acta Diabetologica 2010;47:251–7.

18.

Holmqvist

Lofman

Samuelsson

. A low incidence of type 1 diabetes between 1977 and 2001 in south-eastern Sweden in areas with high population density and which are more deprived. Diabet Med 2008;25:255–60.

19.

Cardwell

Carson

Patterson

. Secular trends, disease maps and ecological analyses of the incidence of childhood onset Type 1 diabetes in Northern Ireland, 1989-2003. Diabet Med 2007;24:289–95.

20.

Haynes

Bulsara

Bower

, et al. Independent effects of socioeconomic status and place of residence on the incidence of childhood type 1 diabetes in Western Australia. Pediatr Diabetes 2006;7:94–100.

21.

Siemiatycki

Colle

Campbell

, et al. Incidence of IDDM in Montreal by ethnic group and by social class and comparisons with ethnic groups living elsewhere. Diabetes 1988;37:1096–1102.

22.

Tarn

Gorsuch

Spencer

, et al. Diabetes and social class. Lancet 1983;2:631–2.

23.

Christau

Kromann

Andersen

, et al. Inci-dence, seasonal and geographical patterns of juvenile-onset insulin-dependent diabetes mellitus in Denmark. Diabetologia 1977;13:281–4.

24.

Hill

Ward

Grace

, et al. Social disparities in the prevalence of diabetes in Australia and in the development of end stage renal disease due to diabetes for Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand. BMC Public Health 2017;17:802.

25.

du Prel

Icks

Grabert

, et al. Socioeconomic conditions and type 1 diabetes in childhood in North Rhine-Westphalia, Germany. Diabetologia 2007;50:720–8.

26.

Crow

Alberti

Parkin

. Insulin dependent diabetes in childhood and material deprivation in northern England, 1977-86. BMJ 1991;303:158–60.

27.

Harron

McKinney

Feltbower

, et al. Incidence rate trends in childhood type 1 diabetes in Yorkshire, UK 1978-2007: effects of deprivation and age at diagnosis in the South Asian and non-South Asian populations. Diabet Med 2011;28:1508–13.

28.

Evans

Newton

Ruta

, et al. Socio-economic status, obesity and prevalence of type 1 and type 2 diabetes mellitus. Diabet Med 2000;17:478–80.

29.

Bruno

Spadea

Picariello

, et al. Early life socioeconomic indicators and risk of type 1 diabetes in children and young adults. J Pediatr 2013;162:600–5.e601.

30.

Thygesen

Daasnes

Thaulow

, et al. Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scand J Public Health 2011;39:12–16.

31.

Schmidt

Sandegaard

, et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015;7:449–90.

32.

Helweg-Larsen

. The Danish Register of Causes of Death. Scand J Public Health 2011;39:26–9.

33.

Jensen

Rasmussen

. Danish education registers. Scand J Public Health 2011;39:91–4.

34.

Danmarks Statistik. Befolkningens uddannelsesstatus https://www.dst.dk/da/Statistik/emner/uddannelse-og-forskning/befolkningens-uddannelsesstatus (accessed 2 March 2022)

35.

UNESCO Institute for Statistics. International Stand-ard Classification of Education ISCED 2011, http://uis.unesco.org/sites/default/files/documents/international-standard-classification-of-education-isced-2011-en.pdf. (accessed 2 March 2022).

36.

Baadsgaard

Quitzau

. Danish registers on personal income and transfer payments. Scand J Public Health 2011;39:103–5.

37.

Smith

Hart

Watt

, et al. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health 1998;52:399–405.

38.

Diderichsen

Andersen

Manuel

, et al. Health inequality–determinants and policies. Scand J Public Health 2012;40:12–105.

39.

Bilsteen

Andresen

Mortensen

, et al. Educational disparities in perinatal health in Denmark in the first decade of the 21st century: a register-based cohort study. BMJ Open 2018;8:e023531.

40.

Galobardes

Lynch

Smith

. Measuring socioeconomic position in health research. Br Med Bull 2007;81–2:21–37.

41.

Galobardes

Shaw

Lawlor

, et al. Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006;60:7–12.

42.

Green

Sortsø

Jensen

, et al. Incidence, morbidity, mortality, and prevalence of diabetes in Denmark, 2000-2011: results from the Diabetes Impact Study 2013. Clin Epidemiol 2015;7:421–30.

43.

Mortensen

Diderichsen

Davey Smith

, et al. Time is on whose side? Time trends in the association between maternal social disadvantage and offspring fetal growth. A study of 1 409 339 births in Denmark, 1981-2004. J Epidemiol Community Health 2009;63:281–5.

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