Zung A, Blumenfeld O, Shehadeh N, Dally Gottfried O, Tenenbaum Rakover Y, Hershkovitz E, Gillis D, Zangen D, Pinhas-Hamiel O, Hanukoglu A, Rachmiel M, Shalitin S. Increase in the incidence of type 1 diabetes in Israeli children following the Second Lebanon War.
Pediatr Diabetes 2012;
13:326-33. [PMID:
22151880 DOI:
10.1111/j.1399-5448.2011.00838.x]
[Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 10/19/2011] [Accepted: 10/28/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND
Type 1 diabetes is an autoimmune disease occurring in genetically susceptible individuals. The precipitating cause is unclear. Recently, the Second Lebanon War exposed a large civilian population in northern Israel to significant psychological stress in the form of repeated barrages of missile attacks.
HYPOTHESIS
We hypothesized that trends in regional incidence of type 1 diabetes before and after the war would reflect an association with stress.
METHODS
All type 1 diabetes patients aged 0-17 yr who were reported to the Israel Juvenile Diabetes Register (n = 1822) in the four pre-war (2002-2005) and two post-war years (2006-2007) were included in the study. The patients were stratified by gender, age, ethnicity, family history of type 1 diabetes, season at diagnosis, and region of residency, namely, those who lived in the northern regions that were attacked and those in other regions.
RESULTS
The post-war incidence of type 1 diabetes was increased in the northern regions (rate ratio, RR = 1.27; p = 0.037), with no change in the other regions. This change was more prominent in males (RR = 1.55; p = 0.005) but similar in summer and winter, in different ages, and in different ethnic groups. There was no change in the proportion of new patients with a family history of the disease.
CONCLUSIONS
For the first time in a large population, we found a positive association between the trauma of war and an increase in the incidence of type 1 diabetes in children and adolescents. The increase in incidence was not associated with genetic susceptibility to the disease.
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