2002 - 2012年间青少年1型和2型糖尿病的发病率趋势
Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012.
作者信息
Mayer-Davis Elizabeth J, Lawrence Jean M, Dabelea Dana, Divers Jasmin, Isom Scott, Dolan Lawrence, Imperatore Giuseppina, Linder Barbara, Marcovina Santica, Pettitt David J, Pihoker Catherine, Saydah Sharon, Wagenknecht Lynne
机构信息
From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle.
出版信息
N Engl J Med. 2017 Apr 13;376(15):1419-1429. doi: 10.1056/NEJMoa1610187.
BACKGROUND
Diagnoses of type 1 and type 2 diabetes in youths present a substantial clinical and public health burden. The prevalence of these diseases increased in the 2001-2009 period, but data on recent incidence trends are lacking.
METHODS
We ascertained cases of type 1 and type 2 diabetes mellitus at five study centers in the United States. Denominators (4.9 million youths annually) were obtained from the U.S. Census or health-plan member counts. After the calculation of annual incidence rates for the 2002-2012 period, we analyzed trends using generalized autoregressive moving-average models with 2-year moving averages.
RESULTS
A total of 11,245 youths with type 1 diabetes (0 to 19 years of age) and 2846 with type 2 diabetes (10 to 19 years of age) were identified. Overall unadjusted estimated incidence rates of type 1 diabetes increased by 1.4% annually (from 19.5 cases per 100,000 youths per year in 2002-2003 to 21.7 cases per 100,000 youths per year in 2011-2012, P=0.03). In adjusted pairwise comparisons, the annual rate of increase was greater among Hispanics than among non-Hispanic whites (4.2% vs. 1.2%, P<0.001). Overall unadjusted incidence rates of type 2 diabetes increased by 7.1% annually (from 9.0 cases per 100,000 youths per year in 2002-2003 to 12.5 cases per 100,000 youths per year in 2011-2012, P<0.001 for trend across race or ethnic group, sex, and age subgroups). Adjusted pairwise comparisons showed that the relative annual increase in the incidence of type 2 diabetes among non-Hispanic whites (0.6%) was lower than that among non-Hispanic blacks, Asians or Pacific Islanders, and Native Americans (P<0.05 for all comparisons) and that the annual rate of increase among Hispanics differed significantly from that among Native Americans (3.1% vs. 8.9%, P=0.01). After adjustment for age, sex, and race or ethnic group, the relative annual increase in the incidence of type 1 diabetes was 1.8% (P<0.001) and that of type 2 diabetes was 4.8% (P<0.001).
CONCLUSIONS
The incidences of both type 1 and type 2 diabetes among youths increased significantly in the 2002-2012 period, particularly among youths of minority racial and ethnic groups. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention.).
背景
青少年1型和2型糖尿病的诊断带来了巨大的临床和公共卫生负担。这些疾病的患病率在2001 - 2009年期间有所上升，但缺乏近期发病率趋势的数据。
方法
我们在美国的五个研究中心确定了1型和2型糖尿病病例。分母（每年490万青少年）来自美国人口普查或健康计划成员数量。在计算2002 - 2012年期间的年发病率后，我们使用具有两年移动平均值的广义自回归移动平均模型分析趋势。
结果
共识别出11245名1型糖尿病青少年（0至19岁）和2846名2型糖尿病青少年（10至19岁）。1型糖尿病总体未调整的估计发病率每年增加1.4%（从2002 - 2003年每10万名青少年每年19.5例增加到2011 - 2012年每10万名青少年每年21.7例，P = 0.03）。在调整后的成对比较中，西班牙裔青少年的年增长率高于非西班牙裔白人（4.2%对1.2%，P < 0.001）。2型糖尿病总体未调整的发病率每年增加7.1%（从2002 - 2003年每10万名青少年每年9.0例增加到2011 - 2012年每10万名青少年每年12.5例，种族或族裔群体、性别和年龄亚组的趋势P < 0.001）。调整后的成对比较显示，非西班牙裔白人中2型糖尿病发病率的相对年增长率（0.6%）低于非西班牙裔黑人、亚洲人或太平洋岛民以及美洲原住民（所有比较P < 0.05），且西班牙裔的年增长率与美洲原住民有显著差异（3.1%对8.9%，P = 0.01）。在调整年龄、性别和种族或族裔群体后，1型糖尿病发病率的相对年增长率为1.8%（P < 0.001），2型糖尿病为4.8%（P < 0.001）。
结论
2002 - 2012年期间，青少年中1型和2型糖尿病的发病率均显著上升，尤其是在少数族裔青少年中。（由美国国立糖尿病、消化和肾脏疾病研究所及疾病控制和预防中心资助。）
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