ArticlesIncidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study
Introduction
Wide variation in incidence of type 1 diabetes in children younger than 15 years has been well characterised by registry reports from the EURODIAB study group within Europe1 and the DIAMOND project group worldwide.2 The DIAMOND project also analysed trends by continent in the period 1990–99, and showed increases in every region except Central America and the West Indies. In Europe, where numbers of cases are large enough to enable useful comparisons of rises in incidence in different age-groups, evidence shows that increases in incidence were highest in the youngest age-group.3 Furthermore, analysis of EURODIAB registration data for 1989–98 in regions within Europe shows that rates of increase differed significantly and were highest in central and eastern European countries.1
The emergence of type 2 diabetes in children and adolescents has received much attention, but this issue should not be allowed to overshadow the rapid rises in type 1 diabetes in this age-group. Although in a few countries most cases in children will be type 2 diabetes,4 in most European countries type 1 diabetes is, and will probably remain, the predominant form of this disease.5 Prediction of future numbers is important to facilitate plans for the delivery of care and treatment of complications that might arise in early adulthood in these children. We aim to document trends in incidence of childhood type 1 diabetes in Europe during 1989–2003, and to use this information to predict the future burden of this disease in European children.
Section snippets
Inclusion criteria and region selection
Case inclusion criteria were as previously described for the EURODIAB registers6—new diagnoses of type 1 (insulin-dependent) diabetes mellitus in children younger than 15 years who were usually resident in the geographically defined region. Completeness of registration was estimated separately for three 5-year periods by capture-recapture methods,7 for which independent primary and secondary sources of ascertainment are needed. In most centres, the primary sources of ascertainment were hospital
Results
Table 1 shows the total numbers of cases registered during 1989–2003 in each of the 20 centres and the age-standardised incidence rates in the three 5-year periods. Most centres maintained greater than 90% completeness of ascertainment in all three periods, with many achieving in excess of 95%. For all but two centres, the estimated annual increases in incidence were significant. Use of a log linear trend to summarise these data was considered appropriate because the test for departure from
Discussion
From review of worldwide epidemiology of childhood type 1 diabetes,10 we noted that Europe provides the most informative data about present incidence trends; European estimates of age-group-specific annual increases have narrower CIs than do estimates from other continents, indicating greater precision. We have extended the analysis of European trends to confirm that the highest rates of increase, at least in relative terms, arise in the youngest age-groups. The most striking changes over time
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