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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, Przemystawa
Gimeno, Suely GA
Chuang, Lee Ming
Roberts, Christine L.
Parslow, Roger C.
Wadsworth, Emma JK
Chetwynd, Amanda
Brigis, Girts
Urbonaite, Brone
Šipetić, Sandra
Schober, Edith
Devoti, Gabriele
Ionescu-Tirgoviste, Constantin
de Beaufort, Carine E.
Stoyanov, Denka
Buschard, Karsten
Radon, Katja
Glatthaar, Christopher
Patterson, Chris C.
Department of Public Health and Epidemiology
Keywords: Birth order;Diabetes mellitus;Epidemiology;Meta-analysis;Type 1;3.3 Health sciences;3.2 Clinical medicine;1.1. Scientific article indexed in Web of Science and/or Scopus database;Epidemiology
Issue Date: Apr-2011
Citation: Cardwell , C R , Stene , L C , Joner , G , Bulsara , M K , Cinek , O , Rosenbauer , J , Ludvigsson , J , Svensson , J , Goldacre , M J , Waldhoer , T , Jarosz-Chobot , P , Gimeno , S GA , Chuang , L M , Roberts , C L , Parslow , R C , Wadsworth , E JK , Chetwynd , A , Brigis , G , Urbonaite , B , Šipetić , S , Schober , E , Devoti , G , Ionescu-Tirgoviste , C , de Beaufort , C E , Stoyanov , D , Buschard , K , Radon , K , Glatthaar , C & Patterson , C C 2011 , ' Birth order and childhood type 1 diabetes risk : A pooled analysis of 31 observational studies ' , International Journal of Epidemiology , vol. 40 , no. 2 , dyq207 , pp. 363-374 .
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 (I2=67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children <5years of age (n=25 studies, maternal age adjusted OR=0.84 95% CI 0.75, 0.93; I2=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. Published by Oxford University Press on behalf of the International Epidemiological Association
Description: Funding Information: This pooled analysis was not directly funded but the authors acknowledge support for the conduct of the original studies from the following: the Czech Republic Ministry of Education (grant MSM 0021620814), Department of Health of Taiwan (DOH 90-TD1028), Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (grant 94/0943-0), The Swedish Child Diabetes Foundation, the NHS National Coordinating Centre for Research Capacity Development UK, Australian National Health and Medical Research Council (NHMRC) (project grant #457302), the Research Council of Norway, the German Research Foundation (grant HE 234/1-1), the Ministry for Science and Technological Development of Serbia (No. 145084, 2006-2010), EUBIROD funded by the European Commission Health Information Strand (DG-SANCO 2005, Contract No 2007115), Diabetes UK and the Northern Ireland Department of Health and Social Services.
ISSN: 0300-5771
Appears in Collections:Research outputs from Pure / Zinātniskās darbības rezultāti no ZDIS Pure

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