Childhood Type 1 diabetes: an environment wide association study across England
File(s)Sheehan2020_Article_ChildhoodType1DiabetesAnEnviro.pdf (2.49 MB)
Published version
Author(s)
Sheehan, Annalisa
Freni Sterrantino, Anna
Fecht, Daniela
Elliott, Paul
Hodgson, Susan
Type
Journal Article
Abstract
Aims:Type 1 Diabetes is an autoimmune disease affecting ~400,000 people across the UK. Environmental factors likely trigger the disease processin genetically susceptible individuals. We assessed the associations between a wide range of environmental factors and childhood type 1 diabetesincidence in England, using an agnostic, ecological Environment Wide Association Study (EnWAS) approach, to generate hypotheses about environmental triggers. Methods:We undertook analyses at the Local Authority District (LAD) level using a national Hospital Episode Statistics (HES) based incident type 1 diabetesdataset, comprising 13,948 cases aged 0-9 years over the period April 2000-March 2011. We compiled LAD-level estimates for a range of potential demographic and environmental risk factors including meteorological, land use and environmental pollution variables. The associations between type 1 diabetesincidence and risk factors were assessed via Poisson regression, disease mapping and ecological regression. 8Results:Case counts by LAD varied from 1 to 236(median 33;inter quartile range: 24-46). Overall type 1 diabetesincidence was 21.2 (95% CI 20.9-21.6) per 100,000individuals. The EnWASand disease mapping indicated that 15out of 53 demographic and environmental risk factors were significantly associated with diabetes incidence after adjusting for multiple testing.These included air pollutants (particulate matter, nitrogen dioxide, nitrogen oxides, carbon monoxide, all inversely associated), as well as lead in soil, radon, outdoor light at night, overcrowding, population density and ethnicity. Disease mapping revealed spatial heterogeneity in type 1 diabetesrisk. The ecological regression found anassociationbetween type 1 diabetesand thelivingenvironmentdomainof the Index of Multiple Deprivation(RR 0.995 (95%Credible Interval (CrI)0.991-0.998))and radon potential class (RR 1.044 95%CrI 1.015-1.074). Conclusions:Our analysis identifiesa range of demographic and environmental factors associated with type 1 diabetesin children in England.
Date Issued
2020-05
Date Acceptance
2019-12-06
Citation
Diabetologia, 2020, 63 (5), pp.964-976
ISSN
0012-186X
Publisher
Springer Verlag
Start Page
964
End Page
976
Journal / Book Title
Diabetologia
Volume
63
Issue
5
Copyright Statement
© The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Sponsor
Wellcome Trust
Wellcome Trust
Medical Research Council (MRC)
Medical Research Council (MRC)
Identifier
https://link.springer.com/article/10.1007%2Fs00125-020-05087-7
Grant Number
200682/Z/16/Z
200682/Z/16/Z
G0801056B
MR/L01341X/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
Childhood diabetes
Disease mapping
Environmental exposures
Environment-wide association study
Hospital episode statistics
Routine health data
Type 1 diabetes
NORTHERN ENGLAND
AIR-POLLUTION
YORKSHIRE
TRENDS
DEPRIVATION
IRRADIANCE
SATELLITE
MELLITUS
DISEASE
MODELS
Childhood diabetes
Disease mapping
Environment-wide association study
Environmental exposures
Hospital episode statistics
Routine health data
Type 1 diabetes
Endocrinology & Metabolism
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2020-01-24