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BMC Med. 2017 Nov 8;15(1):199. doi: 10.1186/s12916-017-0958-6.

Fluctuations in the incidence of type 1 diabetes in the United States from 2001 to 2015: a longitudinal study.

Rogers MAM1,2, Kim C3,4,5,6, Banerjee T4, Lee JM4,7.

Author information

1
Department of Internal Medicine, University of Michigan, Building 16, Room 422 W North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, Michigan, 48109-2800, USA. maryroge@umich.edu.
2
Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. maryroge@umich.edu.
3
Department of Internal Medicine, University of Michigan, Building 16, Room 422 W North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, Michigan, 48109-2800, USA.
4
Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
5
Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
6
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
7
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

BACKGROUND:

While the United States has the largest number of children with type 1 diabetes mellitus, less is known regarding adult-onset disease. The present study utilizes nationwide data to compare the incidence of type 1 diabetes in youth (0-19 years) to that of adults (20-64 years).

METHODS:

In this longitudinal study, the Clinformatics® Data Mart Database was used, which contains information from 61 million commercially insured Americans (years 2001-2015). Incidence rates and exact Poisson 95% confidence intervals were calculated by age group, sex, census division, and year of diagnosis. Changes in rates over time were assessed by negative binomial regression.

RESULTS:

Overall, there were 32,476 individuals who developed type 1 diabetes in the cohort. The incidence rate was greatest in youth aged 10-14 years (45.5 cases/100,000 person-years); however, because adulthood spans over a longer period than childhood, there was a greater number of new cases in adults than in youth (n = 19,174 adults; n = 13,302 youth). Predominance in males was evident by age 10 and persisted throughout adulthood. The male to female incidence rate ratio was 1.32 (95% CI 1.30-1.35). The incidence rate of type 1 diabetes in youth increased by 1.9% annually from 2001 to 2015 (95% CI 1.1-2.7%; P < 0.001), but there was variation across regions. The greatest increases were in the East South Central (3.8%/year; 95% CI 2.0-5.6%; P < 0.001) and Mountain divisions (3.1%/year; 95% CI 1.6-4.6%; P < 0.001). There were also increases in the East North Central (2.7%/year; P = 0.010), South Atlantic (2.4%/year; P < 0.001), and West North Central divisions (2.4%/year; P < 0.001). In adults, however, the incidence decreased from 2001 to 2015 (-1.3%/year; 95% CI -2.3% to -0.4%; P = 0.007). Greater percentages of cases were diagnosed in January, July, and August for both youth and adults. The number of new cases of type 1 diabetes (ages 0-64 years) in the United States is estimated at 64,000 annually (27,000 cases in youth and 37,000 cases in adults).

CONCLUSIONS:

There are more new cases of type 1 diabetes occurring annually in the United States than previously recognized. The increase in incidence rates in youth, but not adults, suggests that the precipitating factors of youth-onset disease may differ from those of adult-onset disease.

KEYWORDS:

Age differences; Incidence study; Trends; Type 1 diabetes mellitus

PMID:
29115947
PMCID:
PMC5688827
DOI:
10.1186/s12916-017-0958-6
[Indexed for MEDLINE]
Free PMC Article

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