Thirty years of prospective nationwide incidence of childhood type 1 diabetes: the accelerating increase by time tends to level off in Sweden

Abstract

Objective: During the past few decades, a rapidly increasing incidence of childhood type 1 diabetes (T1D) has been reported from many parts of the world. The change over time has been partly explained by changes in lifestyle causing rapid early growth and weight development. The current study models and analyzes the time trend by age, sex, and birth cohort in an exceptionally large study group.

Research design and methods: The present analysis involved 14,721 incident cases of T1D with an onset of 0-14.9 years that were recorded in the nationwide Swedish Childhood Diabetes Registry from 1978 to 2007. Data were analyzed using generalized additive models.

Results: Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4-23.9) during 1978-1980 to 43.9 (95% CI 40.7-47.3) during 2005-2007. Cumulative incidence by birth cohort shifted to a younger age at onset during the first 22 years, but from the birth year 2000 a statistically significant reversed trend (P < 0.01) was seen.

Conclusions: Childhood T1D increased dramatically and shifted to a younger age at onset the first 22 years of the study period. We report a reversed trend, starting in 2000, indicating a change in nongenetic risk factors affecting specifically young children.

FIG. 1.

A: Incidence of childhood diabetes by calendar year for boys and girls, respectively. Observed and estimated data, GAM; model 4. B: Incidence of childhood diabetes in three ages at onset groups by calendar year. Observed and estimated data, GAM; model 7.

FIG. 2.

A: Cumulative incidence of childhood T1D in five calendar year groups. B: Cumulative incidence of childhood T1D for yearly birth cohorts 2000–2006.