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Title: Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies
Authors: Cardwell, Chris R.
Stene, Lars C.
Joner, Geir
Bulsara, Max K.
Cinek, Ondrej
Rosenbauer, Joachim
Ludvigsson, Johnny
Svensson, Jannet
Goldacre, Michael J.
Waldhoer, Thomas
Jarosz-Chobot, Przemyslawa
Gimeno, Suely Godoy Agostinho [UNIFESP]
Chuang, Lee-Ming
Roberts, Christine L.
Parslow, Roger C.
Wadsworth, Emma J. K.
Chetwynd, Amanda
Brigis, Girts
Urbonaite, Brone
Sipetic, Sandra
Schober, Edith
Devoti, Gabriele
Ionescu-Tirgoviste, Constantin
Beaufort, Carine E. de
Stoyanov, Denka
Buschard, Karsten
Radon, Katja
Glatthaar, Christopher
Patterson, Chris C.
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
Keywords: Diabetes mellitus
type 1
birth order
Issue Date: 1-Apr-2011
Publisher: Oxford Univ Press
Citation: International Journal of Epidemiology. Oxford: Oxford Univ Press, v. 40, n. 2, p. 363-374, 2011.
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.
ISSN: 0300-5771
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