Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/33571 http://dx.doi.org/10.1093/ije/dyq207 |
Resumo: | Background the incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.Methods Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity.Results Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second- or later born children became apparent [fully adjusted OR = 0.90 95% confidence interval (CI) 0.83-0.98; P = 0.02] but this association varied markedly between studies (I(2) = 67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children < 5 years of age (n = 25 studies, maternal age adjusted OR = 0.84 95% CI 0.75, 0.93; I(2) = 23%).Conclusion Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged < 5 years. This finding could reflect increased exposure to infections in early life in later born children. |
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Cardwell, Chris R.Stene, Lars C.Joner, GeirBulsara, Max K.Cinek, OndrejRosenbauer, JoachimLudvigsson, JohnnySvensson, JannetGoldacre, Michael J.Waldhoer, ThomasJarosz-Chobot, PrzemyslawaGimeno, Suely Godoy Agostinho [UNIFESP]Chuang, Lee-MingRoberts, Christine L.Parslow, Roger C.Wadsworth, Emma J. K.Chetwynd, AmandaBrigis, GirtsUrbonaite, BroneSipetic, SandraSchober, EdithDevoti, GabrieleIonescu-Tirgoviste, ConstantinBeaufort, Carine E. deStoyanov, DenkaBuschard, KarstenRadon, KatjaGlatthaar, ChristopherPatterson, Chris C.Queens Univ BelfastNorwegian Inst Publ HlthOslo Univ HospUniv OsloUniv Western AustraliaUniv Notre DameCharles Univ PragueUniv DusseldorfLinkoping UnivGlostrup Univ HospUniv OxfordMed Univ ViennaMed Univ SilesiaUniversidade Federal de São Paulo (UNIFESP)Natl Taiwan Univ HospUniv SydneyUniv LeedsCardiff UnivUniv LancasterRiga Stradins UnivKaunas Univ MedUniv BelgradeUniv LecceN Paulescu Inst DiabetPediat ClinChildrens Diabet CtrRigshospHosp LMU MunichSir Charles Gairdner Hosp2016-01-24T14:06:19Z2016-01-24T14:06:19Z2011-04-01International Journal of Epidemiology. Oxford: Oxford Univ Press, v. 40, n. 2, p. 363-374, 2011.0300-5771http://repositorio.unifesp.br/handle/11600/33571http://dx.doi.org/10.1093/ije/dyq20710.1093/ije/dyq207WOS:000289165800015Background the incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.Methods Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity.Results Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second- or later born children became apparent [fully adjusted OR = 0.90 95% confidence interval (CI) 0.83-0.98; P = 0.02] but this association varied markedly between studies (I(2) = 67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children < 5 years of age (n = 25 studies, maternal age adjusted OR = 0.84 95% CI 0.75, 0.93; I(2) = 23%).Conclusion Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged < 5 years. This finding could reflect increased exposure to infections in early life in later born children.Czech Republic Ministry of EducationDepartment of Health of TaiwanFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Swedish Child Diabetes FoundationNHS National Coordinating Centre for Research Capacity Development UKAustralian National Health and Medical Research Council (NHMRC)Research Council of NorwayGerman Research FoundationMinistry for Science and Technological Development of SerbiaEuropean Commission Health Information StrandDiabetes UKNorthern Ireland Department of Health and Social ServicesQueens Univ Belfast, Ctr Publ Hlth, Sch Med Dent & Biomed Sci, Belfast BT12 6BJ, Antrim, North IrelandNorwegian Inst Publ Hlth, Div Epidemiol, Oslo, NorwayOslo Univ Hosp, Oslo Diabet Res Ctr, Oslo, NorwayUniv Oslo, Inst Hlth Management & Hlth Econ, Oslo, NorwayUniv Western Australia, Telethon Inst Child Hlth Res, Ctr Child Hlth Res, Perth, WA 6009, AustraliaUniv Notre Dame, Inst Hlth & Rehabil Res, Fremantle, AustraliaCharles Univ Prague, Sch Med 2, Prague, Czech RepublicUniv Dusseldorf, Leibniz Inst, Inst Biometr & Epidemiol, German Diabet Ctr, Dusseldorf, GermanyLinkoping Univ, Dept Paediat, Linkoping, SwedenLinkoping Univ, Diabet Res Ctr, Linkoping, SwedenGlostrup Univ Hosp, Dept Pediat, Glostrup, DenmarkUniv Oxford, Dept Publ Hlth, Oxford, EnglandMed Univ Vienna, Dept Epidemiol, Vienna, AustriaMed Univ Silesia, Dept Pediat Endocrinol & Diabet, Katowice, PolandUniversidade Federal de São Paulo, Dept Prevent Med, São Paulo, BrazilNatl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, TaiwanUniv Sydney, Kolling Inst Med Res, Sydney, NSW 2006, AustraliaUniv Leeds, Paediat Epidemiol Grp, Leeds, W Yorkshire, EnglandCardiff Univ, Ctr Occupat & Hlth Psychol, Cardiff, S Glam, WalesUniv Lancaster, Dept Math & Stat, Lancaster, EnglandRiga Stradins Univ, Dept Publ Hlth & Epidemiol, Riga, LatviaKaunas Univ Med, Inst Endocrinol, Kaunas, LithuaniaUniv Belgrade, Sch Med, Inst Epidemiol, Belgrade, SerbiaMed Univ Vienna, Dept Paediat, Vienna, AustriaUniv Lecce, Dept Social Sci & Commun, I-73100 Lecce, ItalyN Paulescu Inst Diabet, Nutr & Metab Dis Clin, Bucharest, RomaniaPediat Clin, Luxembourg, LuxembourgChildrens Diabet Ctr, Sofia, BulgariaRigshosp, Bartholin Inst, DK-2100 Copenhagen, DenmarkHosp LMU Munich, Inst Occupat & Environm Med, Munich, GermanyHosp LMU Munich, Outpatient Clin Occupat & Environm Med, Munich, GermanySir Charles Gairdner Hosp, Perth, WA, AustraliaUniversidade Federal de São Paulo, Dept Prevent Med, São Paulo, BrazilCzech Republic Ministry of Education: MSM 0021620814Department of Health of Taiwan: DOH 90-TD1028FAPESP: 94/0943-0Australian National Health and Medical Research Council (NHMRC): 457302German Research Foundation: HE 234/1-1Ministry for Science and Technological Development of Serbia: 145084European Commission Health Information Strand: 2007115Web of Science363-374engOxford Univ PressInternational Journal of Epidemiologyhttp://www.oxfordjournals.org/access_purchase/self-archiving_policyb.htmlinfo:eu-repo/semantics/openAccessDiabetes mellitustype 1epidemiologybirth ordermeta-analysisBirth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studiesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlereponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/335712016-01-24 12:06:19.595metadata only accessoai:repositorio.unifesp.br:11600/33571Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652016-01-24T14:06:19Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies |
title |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies |
spellingShingle |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies Cardwell, Chris R. Diabetes mellitus type 1 epidemiology birth order meta-analysis |
title_short |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies |
title_full |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies |
title_fullStr |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies |
title_full_unstemmed |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies |
title_sort |
Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies |
author |
Cardwell, Chris R. |
author_facet |
Cardwell, Chris R. Stene, Lars C. Joner, Geir Bulsara, Max K. Cinek, Ondrej Rosenbauer, Joachim Ludvigsson, Johnny Svensson, Jannet Goldacre, Michael J. Waldhoer, Thomas Jarosz-Chobot, Przemyslawa Gimeno, Suely Godoy Agostinho [UNIFESP] Chuang, Lee-Ming Roberts, Christine L. Parslow, Roger C. Wadsworth, Emma J. K. Chetwynd, Amanda Brigis, Girts Urbonaite, Brone Sipetic, Sandra Schober, Edith Devoti, Gabriele Ionescu-Tirgoviste, Constantin Beaufort, Carine E. de Stoyanov, Denka Buschard, Karsten Radon, Katja Glatthaar, Christopher Patterson, Chris C. |
author_role |
author |
author2 |
Stene, Lars C. Joner, Geir Bulsara, Max K. Cinek, Ondrej Rosenbauer, Joachim Ludvigsson, Johnny Svensson, Jannet Goldacre, Michael J. Waldhoer, Thomas Jarosz-Chobot, Przemyslawa Gimeno, Suely Godoy Agostinho [UNIFESP] Chuang, Lee-Ming Roberts, Christine L. Parslow, Roger C. Wadsworth, Emma J. K. Chetwynd, Amanda Brigis, Girts Urbonaite, Brone Sipetic, Sandra Schober, Edith Devoti, Gabriele Ionescu-Tirgoviste, Constantin Beaufort, Carine E. de Stoyanov, Denka Buschard, Karsten Radon, Katja Glatthaar, Christopher Patterson, Chris C. |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.institution.none.fl_str_mv |
Queens Univ Belfast Norwegian Inst Publ Hlth Oslo Univ Hosp Univ Oslo Univ Western Australia Univ Notre Dame Charles Univ Prague Univ Dusseldorf Linkoping Univ Glostrup Univ Hosp Univ Oxford Med Univ Vienna Med Univ Silesia Universidade Federal de São Paulo (UNIFESP) Natl Taiwan Univ Hosp Univ Sydney Univ Leeds Cardiff Univ Univ Lancaster Riga Stradins Univ Kaunas Univ Med Univ Belgrade Univ Lecce N Paulescu Inst Diabet Pediat Clin Childrens Diabet Ctr Rigshosp Hosp LMU Munich Sir Charles Gairdner Hosp |
dc.contributor.author.fl_str_mv |
Cardwell, Chris R. Stene, Lars C. Joner, Geir Bulsara, Max K. Cinek, Ondrej Rosenbauer, Joachim Ludvigsson, Johnny Svensson, Jannet Goldacre, Michael J. Waldhoer, Thomas Jarosz-Chobot, Przemyslawa Gimeno, Suely Godoy Agostinho [UNIFESP] Chuang, Lee-Ming Roberts, Christine L. Parslow, Roger C. Wadsworth, Emma J. K. Chetwynd, Amanda Brigis, Girts Urbonaite, Brone Sipetic, Sandra Schober, Edith Devoti, Gabriele Ionescu-Tirgoviste, Constantin Beaufort, Carine E. de Stoyanov, Denka Buschard, Karsten Radon, Katja Glatthaar, Christopher Patterson, Chris C. |
dc.subject.eng.fl_str_mv |
Diabetes mellitus type 1 epidemiology birth order meta-analysis |
topic |
Diabetes mellitus type 1 epidemiology birth order meta-analysis |
description |
Background the incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.Methods Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity.Results Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second- or later born children became apparent [fully adjusted OR = 0.90 95% confidence interval (CI) 0.83-0.98; P = 0.02] but this association varied markedly between studies (I(2) = 67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children < 5 years of age (n = 25 studies, maternal age adjusted OR = 0.84 95% CI 0.75, 0.93; I(2) = 23%).Conclusion Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged < 5 years. This finding could reflect increased exposure to infections in early life in later born children. |
publishDate |
2011 |
dc.date.issued.fl_str_mv |
2011-04-01 |
dc.date.accessioned.fl_str_mv |
2016-01-24T14:06:19Z |
dc.date.available.fl_str_mv |
2016-01-24T14:06:19Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
International Journal of Epidemiology. Oxford: Oxford Univ Press, v. 40, n. 2, p. 363-374, 2011. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/33571 http://dx.doi.org/10.1093/ije/dyq207 |
dc.identifier.issn.none.fl_str_mv |
0300-5771 |
dc.identifier.doi.none.fl_str_mv |
10.1093/ije/dyq207 |
dc.identifier.wos.none.fl_str_mv |
WOS:000289165800015 |
identifier_str_mv |
International Journal of Epidemiology. Oxford: Oxford Univ Press, v. 40, n. 2, p. 363-374, 2011. 0300-5771 10.1093/ije/dyq207 WOS:000289165800015 |
url |
http://repositorio.unifesp.br/handle/11600/33571 http://dx.doi.org/10.1093/ije/dyq207 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
International Journal of Epidemiology |
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http://www.oxfordjournals.org/access_purchase/self-archiving_policyb.html info:eu-repo/semantics/openAccess |
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http://www.oxfordjournals.org/access_purchase/self-archiving_policyb.html |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
363-374 |
dc.publisher.none.fl_str_mv |
Oxford Univ Press |
publisher.none.fl_str_mv |
Oxford Univ Press |
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reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
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Universidade Federal de São Paulo (UNIFESP) |
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UNIFESP |
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