Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies

Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies

Author Cardwell, Chris R. Google Scholar
Stene, Lars C. Google Scholar
Joner, Geir Google Scholar
Bulsara, Max K. Google Scholar
Cinek, Ondrej Google Scholar
Rosenbauer, Joachim Google Scholar
Ludvigsson, Johnny Google Scholar
Svensson, Jannet Google Scholar
Goldacre, Michael J. Google Scholar
Waldhoer, Thomas Google Scholar
Jarosz-Chobot, Przemyslawa Google Scholar
Gimeno, Suely Godoy Agostinho Autor UNIFESP Google Scholar
Chuang, Lee-Ming Google Scholar
Roberts, Christine L. Google Scholar
Parslow, Roger C. Google Scholar
Wadsworth, Emma J. K. Google Scholar
Chetwynd, Amanda Google Scholar
Brigis, Girts Google Scholar
Urbonaite, Brone Google Scholar
Sipetic, Sandra Google Scholar
Schober, Edith Google Scholar
Devoti, Gabriele Google Scholar
Ionescu-Tirgoviste, Constantin Google Scholar
Beaufort, Carine E. de Google Scholar
Stoyanov, Denka Google Scholar
Buschard, Karsten Google Scholar
Radon, Katja Google Scholar
Glatthaar, Christopher Google Scholar
Patterson, Chris C. Google Scholar
Institution 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
Hosp LMU Munich
Sir Charles Gairdner Hosp
Abstract 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.
Keywords Diabetes mellitus
type 1
birth order
Language English
Sponsor Czech Republic Ministry of Education
Department of Health of Taiwan
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Swedish Child Diabetes Foundation
NHS National Coordinating Centre for Research Capacity Development UK
Australian National Health and Medical Research Council (NHMRC)
Research Council of Norway
German Research Foundation
Ministry for Science and Technological Development of Serbia
European Commission Health Information Strand
Diabetes UK
Northern Ireland Department of Health and Social Services
Grant number Czech Republic Ministry of Education: MSM 0021620814
Department of Health of Taiwan: DOH 90-TD1028
FAPESP: 94/0943-0
Australian National Health and Medical Research Council (NHMRC): 457302
German Research Foundation: HE 234/1-1
Ministry for Science and Technological Development of Serbia: 145084
European Commission Health Information Strand: 2007115
Date 2011-04-01
Published in International Journal of Epidemiology. Oxford: Oxford Univ Press, v. 40, n. 2, p. 363-374, 2011.
ISSN 0300-5771 (Sherpa/Romeo, impact factor)
Publisher Oxford Univ Press
Extent 363-374
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000289165800015

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