Temporal trends in incidence of pediatric type 1 diabetes in Alabama: 2000-2017

Pediatr Diabetes. 2020 Feb;21(1):40-47. doi: 10.1111/pedi.12927. Epub 2019 Oct 16.


Objective: The incidence of type 1 diabetes has increased in the United States and worldwide. We hypothesized that trends in the annual incidence rates of childhood-onset type 1 diabetes in the state of Alabama would be different by race and sex.

Methods: We performed a retrospective observational cohort study, analyzing children with type 1 diabetes (n = 3770) managed at the Children's Hospital of Alabama between 2000 and 2017. We compared crude incidence rates using negative binomial regression models and analyzed differences in annual trends of age-adjusted incidence by race and sex using joinpoint regression.

Results: The crude type 1 diabetes incidence rate was estimated at 16.7 per 100 000 children <19 years of age in Alabama. Between 2000 and 2007, there was an increase in age-adjusted incidence of type 1 diabetes with an annual percent change (APC) of 10% from 2000 to 2007 and a 1.7% APC decrease from 2007 to 2017. The age-adjusted incidence for Whites and Blacks increased with an average annual percentage change (AAPC) of 4.4% and 2.8%, respectively. A nearly 11% increasing trend in age-adjusted incidence was observed for both races, though the increase plateaued in 2006 for Whites and 2010 for Blacks.

Conclusions: Following significantly increasing annual trends for both races, the age-adjusted rate remained statistically stable for Whites and decreased significantly for Blacks. Longer-sustained trend increases for Blacks resulted in type 1 diabetes incidence tripling compared to the doubling of the rate for Whites.

Keywords: diabetes in youth; epidemiology; incidence; trends; type 1 diabetes.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Age Distribution
  • Alabama / epidemiology
  • Black or African American / statistics & numerical data*
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Regression Analysis
  • Retrospective Studies
  • Sex Distribution
  • White People / statistics & numerical data*
  • Young Adult