Sex Ratio by Age Group

The incidence data in 5-year age groups were available for both sexes for 62 populations (Table 7A.4 and 7A.5). Among children aged 4 years or under the male excess in incidence was

TYPE 1 DIABETES: GLOBAL EPIDEMIOLOGY Table 7A.4 Age-specific incidence of Type 1 diabetes in children aged 14 years or under (per 100 000 population)

Region

Incidence

Region

Incidence

Country and area

Males

Females

Male

or female

excess * *

0-4 y

5-9 y

10-14 y

0-5 y

5-9 y

10-14 y

0-4 y

5-9 y

10-14

Africa

Libya

Benghazi [47]

2.0

5.8

13.9

2.3

8.6

15.6

-0.15

-0.48

-0.12

North America

Canada [25]

Prince Edward Isl.

28.6

31.3

32.2

8.5

25.1

38.5

2.37

0.25

-0.20

Montreal

7.7

11.6

14.1

5.8

11.9

11.4

0.33

-0.05

0.16

United States

North Dakota [25]

11.6

23.9

29.0

9.1

18.5

20.8

0.28

0.29

0.35

Wisconsin (part) [25]

9.9

17.1

33.1

8.2

17.0

23.3

0.21

0.01

0.42

Rochester [25]

13.5

12.2

21.3

8.7

15.4

30.6

0.55

-0.26

-0.44

Colorado [51] *

Non-Hispanics

10.1

18.8

22.5

7.3

17.6

22.4

0.38

0.07

0.00

Hispanics

4.9

4.4

12.0

3.4

11.7

18.3

0.44

-1.66

-0.53

Jefferson county [52]

White

10.0

21.5

20.0

6.2

24.3

26.0

0.61

-0.13

-0.30

Black

1.4

2.9

1.4

8.3

14.9

8.3

-4.93

-4.14

-4.93

San Diego [25]

7.0

7.0

14.6

3.6

11.3

12.6

0.94

-0.61

0.16

Central America and the West Indies

Cuba [25]

1.5

3.4

2.5

1.9

3.0

3.5

-0.27

0.13

-0.40

South America

Brazil [58]

State of Sao Paulo

2.4

5.3

10.1

7.6

12.7

8.5

-2.17

-1.40

0.19

Asia

China

Shanghai [40]

0.3

0.3

0.6

0.3

1.5

0.6

-0.08

-4.80

-0.05

Israel [27]

2.2

4.5

6.5

2.7

9.1

8.2

-0.23

-1.02

-0.26

Japan

Hokkaido [25]

0.5

0.8

2.2

1.5

2.6

4.2

-2.00

-2.25

-0.91

Republic of Korea

Seoul [39]

0.4

0.2

1.0

0.4

0.5

0.9

0.00

-1.50

0.11

Kuwait [62]

14.9

16.7

18.7

10.7

14.8

17.9

0.40

0.13

0.05

Russia

Novosibirsk [63]

2.3

2.8

8.7

1.9

4.9

7.8

0.21

-0.75

0.12

Oceania

Australia

New South Wales [64]

7.1

14.0

21.0

8.5

17.6

22.1

-0.20

-0.26

0.05

New Zealand

Canterbury [25]

4.2

5.2

20.9

10.8

7.2

20.1

-1.57

-0.39

0.04

Europe

Austria [27]

5.1

8.2

10.3

4.5

8.3

9.9

0.13

-0.01

0.04

Belgium

Antwerp [27]

3.7

12.5

11.6

5.8

11.2

14.1

-0.57

0.12

-0.22

Croatia

Zagreb [67]

2.2

9.1

12.3

3.4

4.8

12.6

-0.55

0.90

-0.02

Denmark

3 counties [27]

16.5

12.4

35.6

8.5

26.2

29.6

0.94

-1.11

0.20

Estonia [48]

3.1

11.0

18.1

3.2

13.5

13.3

-0.03

-0.23

0.36

Finland [43]

28.0

39.6

45.3

27.1

38.1

35.5

0.03

0.04

(continued )

Table 7A.4 (continued)

Region Incidence

Country and area Males Females Male or female excess *

0-4 y 5-9 y 10-14 y 0-5 y 5-9 y 10-14 y 0-4 y 5-9 y 10-14 y

France

4 regions [27] Greece [69] Hungary [27] Italy

Marche [72] Lazio [27] Liguria [73] Lombardia [27] Sardinia [74] Eastern Sicily [27] Pavia [76] Turin [75] Latvia [68] Lithuania [68] Macedonia [44] Malta [78] Netherlands [27] Norway [27]

8 counties Poland

Portugal

3 regions [27] Romania

Bucharest [27] Slovakia [80] Slovenia [27] Spain

Catalonia [27] Sweden [100] United Kingdom [82] Leicestershire [25] Northern Ireland [27] Oxford [27] Scotland [25] Tayside [25] Yorkshire [25] Yuogoslavia Belgrade [84]

2.9 8.6 9.6 1.2 3.4 3.1 9.1 15.6 19.5 6.1 13.3 17.7

13.6 13.8 18.7 11.3 13.4 20.0 12.2 19.9 25.8 15.6 20.7 18.2

0.42

0.25

-0.34

0.27

-0.19

0.04

0.05

0.08

-0.04

0.05

-0.05

-0.05

0.13

0.53

0.20

0.02

-0.21

0.07

0.00

0.83

0.11

0.14

0.25

0.30

3.89

-0.40

0.08

1.85

-0.30

0.18

0.03

0.16

0.19

0.16

-0.28

0.05

0.41

-0.25

-0.12

0.38

-0.56

0.14

0.49

-0.30

0.04

0.12

-0.14

0.05

0.70

0.00

0.15

1.12

0.16

0.00

0.80

-0.05

-0.33

0.27

0.15

0.08

3.70

0.60

0.68

6.29

-1.40

0.78

0.12

-0.15

-0.70

0.40

-1.10

-0.60

0.38

-0.11

-0.04

0.16

-0.04

0.08

0.03

-0.05

0.13

0.50

0.04

-0.15

0.19

0.12

0.42

0.35

0.07

0.20

0.12

0.03

0.00

0.09

-0.17

0.64

0.02

-0.02

0.08

0.39

-0.36

-0.13

M, male; F, female; T, total *Age 17 years or under.

* ^Negative value indicates a female excess and positive value a male excess in the incidence of Type 1 diabetes. Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

found in 66% of the populations, whereas in the age group of 5-9 years there was a female excess in 63% of the populations. In the age group 10-14 years there was again a male excess in incidence in the majority, 60% of the populations.

A female excess in Type 1 diabetes incidence among children aged 4 years or under was found in 64% of the low incidence (<6.5/100 000) populations. However, a male excess increased with a growing incidence. Thus, in 62% of the populations

Slovenia Slovakia Bucharest.ROM Malta Belgrade, YUG Antwerp, BEL Tayside.GBR Latvia

Poland. 9 west prov.

Lithuania Macedonia Poland, 3 cities M arch e, ITA Ligufia.lTA Luxembourg Catalonia,ESP Netherlands France, 4 reg.

Denmark, 3 count.

Leicestershire,GBR Hungary Scotland,GBR United Kingdom Greece Sweden Austria Estonia Madrid, ESP Finland Iceland Rzeszow.POL Zagreb.HRV Pavia.lTA Turin,ITA Norway, 8 count N.Ireland,GBR Oxtord.GBR Lazio.lTA Eastern Sicily,ITA Sardinia,ITA LombardiaJTA Portugal. 3 reg.

TYPE 1 DIABETES: GLOBAL EPIDEMIOLOGY 81

Europe Americas, Asia, Africa and Oceania

TYPE 1 DIABETES: GLOBAL EPIDEMIOLOGY 81

Europe Americas, Asia, Africa and Oceania

Figure 7A.2 A male to female excess in the age-specific incidence (per 100 000 population) of Type 1 diabetes in children aged 14 years or under. Negative value indicates a female excess and positive value a male excess in the incidence of Type 1 diabetes.

AUS, Australia; BEL, Belgium; BRA, Brazil; BUL, Bulgaria; CAN, Canada; CHN, China; GBR, Great Britain, GRE, Greece; Croatia, HRV; ITA, Italy; JPN, Japan; KOR, Korea; LBY, Libya; MEX, Mexico; NZL, New Zealand; POL, Poland; POR, Portugal; RUS, Russia; ESP, Spain; TZA, Tanzania; USA, United States of America; w, White; n-w, non-White; b, Black; h, Hispanic; n-h, non-Hispanic

Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

with an intermediate (6.5-15.0/100 000) incidence and in 88% of the populations with a high (>15.0/100 000) incidence a male excess in incidence was found. In children aged 5-9 years a female excess in incidence was found in the populations with a low and an intermediate incidence, whereas 71% of the populations with a high incidence had a male excess. In the oldest age group (10-14 years old) a male excess in incidence was also found in children aged 10-14 years, in 56% of the populations with an intermediate and in 77% of the populations with high incidence, whereas of the populations with a low incidence 55% had a female excess in incidence.

The sex ratio in Type 1 diabetes incidence diverged between continents (Table 7A.6). Europe was the only continent where the slight male excess in incidence was seen: 55% of the populations had a male excess in the incidence of Type 1 diabetes. The sex ratio within Europe varied from a female excess in Slovenia (ratio —0.48) to the male excess in Portugal (ratio 2.06). In the North American continent a female excess in incidence was found in 67% of the populations and the greatest female excess (ratio —2.12) was in the Black population of Jefferson County, Alabama, USA. The male excess in incidence was found mainly in the northern part of the continent, in Colorado, Wisconsin and North Dakota in the USA and on Prince Edward Island, Canada. The number of populations from other continents is relatively small. Among populations from Asia, Central

CO Inj

Age 0-4

Age 5-9

Age 10-14

Bucharest, ROM

JoHemon (b),USA Säo Paulo.BRA Hokkaido ,JPN Canterbury, fiZL Poland. 3 cities Antwerp,BEL Zagreb.HRV Malta Cuba Israel

N-S Waies.AUS N.Ireland,GBR Latvia Benghazi,LBV La2io,ITA Shanghai,CH N Allegheny (w),U$A Ma/cfie,ITA Estonia Lombardy, ITA Seoul ,KOR Liguria.lTA Yorkshire, G8R United Kingdom Turin ITA Finland Hungaiv Tays>de,GBH Netherlands Slovakia Scotland,GBR Austria Sardinla.lTA Sweden Allegheny (n-w),U$A Wisconsin,USA Novosibirsk, RUS Rzes zow, POL Greece Norm Dakota,USA Montreal,CAN Oxford,GBR Macedonia Cataloma,ESP Colorado (n-h).USA Belgrade.YüG Kuwait Slovenia Lithuania France, * reg. Colorado |h),uSA Leicestershire,GBR Rochester, US A Jefferson (w),USA Norway. 0 count. Poland, 9 west prov. Denmark, 3 count. San Oego.USA Pavia.lTA Pr Edw. Isl.CAN

Portugal. 3 reg.

Eastern Sicily.lTA

Shanghal.CHN

Jefferson (b),USA HoWcaldo JPN Colorado (h),USA Seoul, KOR Bucharest ,ROM Sao Paulo,BRA Denmark. 3 count.

Slovenia

Allegheny (n-wj.USA Novosibirsk,RUS San Diego,USA Macedonia Benghazi,LBY Eastern Soy, ITA Cantertxjry.NZL Belgrade.YUG Mala Pavla.lTA

Rochester, USA N S Wales,AUS Lithuania Estonia Liguria.lTA Greece Tayslde.GBR Slovakia Netherlands Jeflerson (w),USA Catatonia,ESP Poland, 9 west prov. United Kingdom Montreal,CAN Ma/cneJTA Sweden Yorkshire.GBR Austria Norway, 8 count Wisconsin,USA Scotland,GBR Allegheny (w),USA Leicestershire,GBR Finland Oxford.G8R Colorado (n-h).USA Hungary Antwerp .BEL N. Ireland.GBR Kuwait Cuba Rzeszow.POl Turin,ITA Poland. 3 Cities Franco, i reg. Pr. Edw. lsl,CAN Sardinia,I TA North Dakota, USA Lazo.iTA Portugal. 3 reg. lombardy .ITA Zagreb, HRV

Jefferson (b),USA H0Kka«J0,jPN Slovakia Slovenia Colorado (h),USA Rochester,USA Cuba

Allegheny (b).USA France. 4 reg Poland. 9 west pro* Jofte'son (w)pUSA

Antwerp,BEL Pr EOw. ISI..CAN Leicestershire,GBR Belgrade.YUG Benghazi,LS Y Lithuania Allegheny (w),USA Shanghai ,CHN Marche.iTA Catatonia,ESP Hungary Zagreb,HRV Poland, 3 cities Colorado (n-hJ.USA Scotland,GBR Malta Greece Austria Canterbury, NZL Netherlands Kuwait Latvia N-S Wales,AUS Ugurla.lTA Sweden Yorkshire ,G8R Rzes:ov,POL Eastern Seif/.ITA Lombardy ,ITA Seoul, KOR N0v0Sibirsk,RUS United Kingdom Macedonia Norway. 8 count. Montreal, CAN San Diego,USA Pavia,lTA Säo Pauk>,8RA Turin, ITA Oxford,GBR Lazio,ITA Denmark, 3 count.

Finland Sardinia ITA Estonia Nonn Dakota,USA N.Ireland,GBR Wisconsin,USA Tayside.GBR Portugal, 3roo Bucharesi.ROM

Figure 7A.3 A male to female excess in the incidence (per 100 000 population) of Type 1 diabetes in children aged 14 years or under for boys and girls in age groups: 0-4 years, 5-9 years and 10-14 years. Negative value indicates a female excess and positive value a male excess in the incidence of Type 1 diabetes.

AUS, Australia; BEL, Belgium; BRA, Brazil; BUL, Bulgaria; CAN, Canada; CHN, China; GBR, Great Britain, GRE, Greece; Croatia, HRV; ITA, Italy; JPN, Japan; KOR, Korea; LBY, Libya; MEX, Mexico; NZL, New Zealand; POL, Poland; POR, Portugal; RUS, Russia; ESP, Spain; TZA, Tanzania; USA, United States of America; w, White; n-w, non-White; b, Black; h, Hispanic; n-h, non-Hispanic

Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

America and the West Indies only two out of ten populations had a male excess in incidence, and among populations from South America, Africa and Oceania there was a female excess in incidence

Table 7A.6 The global distribution of the populations with a male or female excess in the incidence of Type 1 diabetes

Number of populations with a male or female excess in the incidence of Type 1 diabetes

Table 7A.5 Number of populations (%) with a low (<6.5), intermediate (6.5-15.0) or high (<15.0) incidence of Type 1 diabetes (per 100 000/year) *

Low

Intermediate

High

(<6.5)

(6.5-l5.0)

(>l5.0)

Total

Age < 14 years1

Female excess

l5 (88.2)

24 (60.0)

6 (3l.6)

45 (59.2)

Male excess

2 (ll.8)

l6 (40.0)

l3 (68.4)

3l (4O.8)

Total

l7

40

l9

76

Age 0-4 years2

Female excess

7 (63.6)

l3 (38.2)

2 (ll.8)

2l (33.9)

Male excess

4 (36.4)

2l (6l.8)

l5 (88.2)

4l (66.l)

Total

ll

34

l7

62

Age 5-9 years3

Female excess

8 (72.7)

25 (73.5)

5 (29.4)

39 (62.9)

Male excess

3 (27.3)

9 (26.5)

l2 (70.6)

23 (37.l)

Total

ll

34

l7

62

Age 10-14 years4

Female excess

6 (54.6)

l5 (44.l)

4 (23.5)

25 (40.3)

Male excess

5 (45.5)

l9 (55.9)

l3 (76.5)

37 (59.7)

Total

ll

34

l7

62

*The populations have been divided into three groups according to the incidence (per 100 000/year) percentile point: 25%, 50% and 75% corresponding to the incidence levels (<6.5, 6.5-15.0, >15.0). 1Chi-Square 11.858, df 2, p = 0.003. 2Chi-Square 8.099 df 2, p = 0.017. 3Chi-Square 10.035, df 2, p = 0.007. 4Chi-Square 3.121, df2, p = 0.210. Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

*The populations have been divided into three groups according to the incidence (per 100 000/year) percentile point: 25%, 50% and 75% corresponding to the incidence levels (<6.5, 6.5-15.0, >15.0). 1Chi-Square 11.858, df 2, p = 0.003. 2Chi-Square 8.099 df 2, p = 0.017. 3Chi-Square 10.035, df 2, p = 0.007. 4Chi-Square 3.121, df2, p = 0.210. Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

Figure 7A.4 An association between male to female excess in the age specific incidence of Type 1 diabetes in children aged 14 years or under in 74 population worldwide (Jefferson, USA Black-population (2.1) and Portugal (1.1) have been excluded).

Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

Continent

Male

Female

All

excess

excess

Europe

23

l9 *

42

North America

5

l0

l5

Central America and

l

2

3

the West Indies

South America

0

2

3

Asia

l

6

7

Oceania

0

4

4

Africa

0

3

3

All

30

46

76

*Includes three populations with equal incidence in males and females. Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

*Includes three populations with equal incidence in males and females. Reproduced from Karvonen et al. (1997) Diabetes/Metabolism Reviews. 13(4): 275-91, by permission.

among all populations. All populations with an incidence higher than 23.0/100 000 had a male excess in incidence, and all populations with an incidence lower than 4.5/100 000 had a female excess in incidence (Figure 7A.4). The majority (77%) of the populations which had a male excess in incidence were European. Populations with a female excess in incidence were mainly of Black or Asian origin.

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