Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Study Population
2.2. Type 1 Diabetes Ascertainment
- Age at diagnosis ≤40 years.
- Ongoing insulin therapy at time of recruitment.
- Time from diagnosis to insulin therapy initiation ≤1 year.
2.3. Exposure Variables and Covariables
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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No Diabetes (n = 94,465) | Diabetes Type 1 (n = 371) | Diabetes Type 2 or Others (n = 6575) | Total (N = 101,411) | |
---|---|---|---|---|
Sex | ||||
- Male | 43,264 (45.8%) | 204 (57.6%) | 3602 (54.6%) | 47,070 (46.4%) |
- Female | 51,201 (54.2%) | 167 (45.0%) | 2973 (45.2%) | 54,341 (53.6%) |
Caesarean delivery | ||||
- No | 72,816 (77.1%) | 259 (69.8%) | 4290 (65.2%) | 77,365 (76.3%) |
- Yes | 3489 (3.7%) | 21 (5.7%) | 105 (1.6%) | 3615 (3.6%) |
- Unknown | 18,160 (19.2%) | 91 (24.5%) | 2180 (33.2%) | 20,431 (20.1%) |
Birth order | ||||
- Only child | 14,314 (15.2%) | 69 (18.6%) | 918 (14.0%) | 15,301 (15.1%) |
- First | 24,765 (26.2%) | 99 (26.7%) | 1434 (21.8%) | 26,298 (25.9%) |
- Second | 24,230 (25.6%) | 81 (21.8%) | 1299 (19.8%) | 25,610 (25.3%) |
- Third or more | 16,116 (17.1%) | 50 (13.5%) | 1010 (15.4%) | 17,176 (16.9%) |
- Missing | 15,040 (15.9%) | 72 (19.4%) | 1914 (29.1%) | 17,026 (16.8%) |
Attended daycare | ||||
- No | 25,408 (26.9%) | 77 (20.8%) | 2081 (31.7%) | 27,566 (27.2%) |
- Yes | 54,091 (57.3%) | 222 (59.8%) | 2597 (39.5%) | 56,910 (56.1%) |
- Unknown | 14,966 (15.8%) | 72 (19.4%) | 1897 (28.9%) | 16,935 (16.7%) |
Birth year | ||||
- ≤1955 | 28,978 (30.7%) | 73 (19.7%) | 4142 (63.0%) | 33,193 (32.7%) |
- 1956–1965 | 27,341 (28.9%) | 118 (31.8%) | 1611 (24.5%) | 29,070 (28.7%) |
- 1966–1975 | 21,586 (22.9%) | 97 (26.1%) | 620 (9.4%) | 22,303 (22.0%) |
- 1976–1985 | 9299 (9.8%) | 45 (12.1%) | 175 (2.7%) | 9519 (9.4%) |
- ≥1986 | 7261 (7.7%) | 38 (10.7%) | 27 (0.4%) | 7326 (7.2%) |
Paternal diabetes | ||||
- No | 60,376 (63.9%) | 195 (52.6%) | 2615 (39.8%) | 63,186 (62.3%) |
- Yes, at age < 40 years | 458 (0.5%) | 12 (3.2%) | 63 (1.0%) | 533 (0.5%) |
- Yes, at age ≥ 40 years/unknown | 10,635 (11.3%) | 66 (17.8%) | 1201 (18.3%) | 11,902 (11.7%) |
- Unknown | 22,996 (24.3%) | 98 (26.4%) | 2696 (41.0%) | 25,790 (25.4%) |
Maternal diabetes | ||||
- No | 66,019 (69.9%) | 218 (58.8%) | 2621 (39.9%) | 68,858 (67.9%) |
- Yes, at age < 40 years | 403 (0.4%) | 13 (3.5%) | 94 (1.4%) | 510 (0.5%) |
- Yes, at age ≥ 40 years/unknown | 11,119 (11.8%) | 63 (17.0%) | 1679 (25.5%) | 12,861 (12.7%) |
- Unknown | 16,924 (17.9%) | 77 (20.8%) | 2181 (33.2%) | 19,182 (18.9%) |
Migration background | ||||
- No migration background | 79,517 (84.2%) | 330 (88.9%) | 5375 (81.8%) | 85,222 (84.0%) |
- Has migration background | 14,936 (15.8%) | 41 (11.1%) | 1199 (18.2%) | 16,176 (16.0%) |
- Missing | 12 (0.0%) | 0 (0.0%) | 1 (0.0%) | 13 (0.0%) |
Premature birth (>4 weeks before due date) | ||||
- No | 72,203 (76.4%) | 270 (72.8%) | 4142 (63.0%) | 76,615 (75.5%) |
- Yes | 3179 (3.4%) | 12 (3.2%) | 183 (2.8%) | 3374 (3.3%) |
- Unknown | 19,083 (20.2%) | 89 (24.0%) | 2250 (34.2%) | 21,422 (21.1%) |
Birth weight | ||||
- Light | 8018 (8.5%) | 29 (7.8%) | 511 (7.8%) | 8558 (8.4%) |
- Average | 47,937 (50.7%) | 176 (47.4%) | 2482 (37.7%) | 50,595 (49.9%) |
- Heavy | 8102 (8.6%) | 34 (9.2%) | 401 (6.1%) | 8537 (8.4%) |
- Unknown | 30,408 (32.2%) | 132 (35.6%) | 3181 (48.4%) | 33,721 (33.3%) |
Ever breastfed | ||||
- No | 13,260 (14.0%) | 60 (16.2%) | 604 (9.2%) | 13,924 (13.7%) |
- Yes, >4 months | 18,114 (19.2%) | 66 (17.8%) | 1047 (15.9%) | 19,227 (19.0%) |
- Yes, until 4 months | 21,351 (22.6%) | 79 (21.3%) | 1200 (18.3%) | 22,630 (22.3%) |
- Unknown | 41,740 (44.2%) | 166 (44.7%) | 3724 (56.6%) | 45,630 (45.0%) |
BMI at age 18 | ||||
- Underweight | 8830 (9.3%) | 24 (6.5%) | 397 (6.0%) | 9251 (9.1%) |
- Normal weight | 50,140 (53.1%) | 173 (46.6%) | 2519 (38.3%) | 52,832 (52.1%) |
- Overweight | 5669 (6.0%) | 31 (8.4%) | 567 (16.1%) | 6267 (6.2%) |
- Obese | 213 (0.2%) | 3 (0.8%) | 25 (0.7%) | 241 (0.2%) |
- Missing | 29,613 (31.3%) | 140 (37.7%) | 3067 (46.6%) | 32,820 (32.4%) |
Outcome: Type 1 Diabetes | n a (%) | Hazard Ratio (95% Confidence Interval) | |||||
---|---|---|---|---|---|---|---|
Univariable | Multivariable Full Model b | Multivariable Reduced Model b | |||||
Case Selection | Age at Diagnosis 0–40 Years | Age at Diagnosis 0–15 Years | Age at Diagnosis 16–40 Years | ||||
Birth order | Only child | 15,301 (15.1) | 1 | 1 | 1 | 1 | 1 |
First | 26,298 (25.9) | 0.83 (0.61–1.12) | 0.85 (0.63–1.17) | 0.85 (0.62–1.16) | 0.66 (0.38–1.15) | 0.95 (0.65–1.39) | |
Second | 25,610 (25.3) | 0.69 (0.50–0.96) | 0.70 (0.50–0.96) | 0.69 (0.50–0.96) | 0.54 (0.30–0.95) | 0.78 (0.52–1.15) | |
≥Third | 17,176 (16.9) | 0.66 (0.46–0.95) | 0.65 (0.45–0.94) | 0.65 (0.45–0.94) | 0.42 (0.20–0.87) | 0.77 (0.50–1.19) | |
Unknown | 17,026 (16.8) | 1.07 (0.77–1.49) | 0.61 (0.13–2.91) | 0.63 (0.13–3.01) | 0.74 (0.03–20.23) | 0.62 (0.11–3.66) | |
C-section delivery | No | 77,365 (76.3) | 1 | 1 | 1 | 1 | 1 |
Yes | 3615 (3.6) | 1.51 (0.96–2.37) | 1.32 (0.83–2.08) | 1.35 (0.85–2.12) | 1.68 (0.85–3.31) | 1.13 (0.61–2.10) | |
Unknown | 20,431 (20.1) | 1.48 (1.17–1.89) | 1.46 (0.89–2.42) | 1.43 (0.90–2.29) | 0.97 (0.31–3.02) | 1.58 (0.94–2.65) | |
Attended daycare | No | 27,566 (27.2) | 1 | 1 | 1 | 1 | 1 |
Yes | 56,910 (56.1) | 1.12 (0.85–1.49) | 1.05 (0.79–1.39) | 1.04 (0.79–1.38) | 0.84 (0.47–1.48) | 1.11 (0.80–1.54) | |
Unknown | 16,935 (16.7) | 1.50 (1.08–2.07) | 1.46 (0.31–6.92) | 1.42 (0.30–6.75) | 1.71 (0.06–47.34) | 1.36 (0.23–7.87) | |
Sex | Male | 47,070 (46.4) | 1 | 1 | 1 | 1 | 1 |
Female | 54,341 (53.6) | 0.69 (0.56–0.85) | 0.67 (0.54–0.83) | 0.68 (0.55–0.84) | 0.82 (0.55–1.22) | 0.63 (0.50–0.81) |
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Tanoey, J.; Baechle, C.; Brenner, H.; Deckert, A.; Fricke, J.; Günther, K.; Karch, A.; Keil, T.; Kluttig, A.; Leitzmann, M.; et al. Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort. Int. J. Environ. Res. Public Health 2022, 19, 10880. https://doi.org/10.3390/ijerph191710880
Tanoey J, Baechle C, Brenner H, Deckert A, Fricke J, Günther K, Karch A, Keil T, Kluttig A, Leitzmann M, et al. Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort. International Journal of Environmental Research and Public Health. 2022; 19(17):10880. https://doi.org/10.3390/ijerph191710880
Chicago/Turabian StyleTanoey, Justine, Christina Baechle, Hermann Brenner, Andreas Deckert, Julia Fricke, Kathrin Günther, André Karch, Thomas Keil, Alexander Kluttig, Michael Leitzmann, and et al. 2022. "Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort" International Journal of Environmental Research and Public Health 19, no. 17: 10880. https://doi.org/10.3390/ijerph191710880