Ethnic Differences in the Incidence of Lower Extremity Amputation Secondary to Diabetes Mellitus

Patients of Asian ethnic origin with diabetes mellitus living in the United Kingdom (UK) have been shown to have a higher prevalence of coronary heart disease and renal disease. Little is known about the incidence of lower extremity amputation in this racial group. The incidence of lower extremity amputation was estimated for patients of Asian ethnic origin and White Caucasians with diabetes mellitus in the county of Leicestershire from 1980 to 1985. The age and sex-adjusted incidence rate of lower extremity amputation for the estimated population of patients with diabetes mellitus in patients of Asian ethnic origin was 3.4 (95% CI, 1.1–10.7) cases per 10000 patients year^?1, compared to 14.2 (12.6–15.9) in White Caucasians. Similarly, a lower incidence rate of lower extremity amputation was recorded in patients of Asian ethnic origin without diabetes mellitus (0.4 (0.2-0.6) vs 1.5 (1.4 to 1.6) cases per 10000 persons year^?1). These findings contrast markedly with the high rates of coronary heart disease and renal disease previously reported in patients of Asian ethnic origin residing in the UK.     

Prevalence of diabetes in different regional and religious south Asian communities in Coventry.

The prevalence of Type 2 (non-insulin-dependent) diabetes in different South Asian (Asian) communities was compared during the Coventry Diabetes Study, a cross-sectional house to house screening programme for diabetes. Screening was by capillary whole blood glucose measurement with oral glucose tolerance tests when concentrations were greater than or equal to 6.0 mmol l-1 within 2 h of a meal or greater than or equal to 5.0 mmol l-1 2 h or more after a meal and a random 10% of others. Of the 4395 resident Asians, 94% were represented by five communities: Punjabi Sikhs, Punjabi Hindus, Gujerati Moslems, Gujerati Hindus, and Pakistani Moslems. Response to screening was 77-89% and to glucose tolerance test was 59-79%. Differences in anthropometry, socioeconomic circumstances, and migratory patterns were found, but all groups had a higher prevalence of Type 2 diabetes than Europeans. Gujerati Moslems had the highest age-adjusted prevalence (per 1000) of Type 2 diabetes (males: 160 (95% CI 107-228), females: 204 (95% CI 144-283)) when compared with the other Asian groups (males: Punjabi Sikhs 89(72-110), Pakistani Moslems 91(67-120), Gujerati Hindus 84(57-120), Punjabi Hindu 113(74-171); females: Punjabi Sikhs 75(60-94), Pakistani Moslems 103(78-133), Gujerati Hindus 88(62-122), Punjabi Hindu 116(77-174)). That all the Asian groups had a high prevalence of diabetes, in spite of their known dietary, cultural, and socioeconomic differences, suggests that the Asian predisposition to Type 2 diabetes is inherited although environmental factors may be necessary for this to be expressed.     

British South Asians aged 13-16 years have higher fasting glucose and insulin levels than Europeans.

AIM: To examine whether plasma glucose, insulin resistance and markers of adiposity differed between British adolescents of South Asian and European origin. METHODS: School-based cross-sectional study (1998-2000), in which detailed measurements of adiposity, fasting plasma glucose and serum insulin were made in 90 South Asian and 1248 European pupils (overall 69% response rate). RESULTS: Compared with Europeans, South Asian subjects had higher mean fasting insulin levels (percentage mean difference 17.2%, 95% confidence interval 7.2-26.1%, P = 0.001), a higher mean fasting glucose (mean difference 0.19 mmol/l, 95% confidence interval 0.08-0.29 mmol/l, P = 0.0005) and a higher prevalence of impaired fasting glucose (> or = 6.1 mmol/l) (5.6% vs. 1.5%, odds ratio 3.9, 95% confidence interval 1.4-10.9, P = 0.004). Although South Asian children tended to have slightly higher indices of adiposity than Europeans (other than body mass index), the differences in glucose and insulin levels persisted after adjustment for adiposity and for pubertal status. CONCLUSIONS: The predisposition to Type 2 diabetes observed in South Asian adults is apparent before adult life. Establishing the contributions of the childhood and fetal environments and of genetic factors to the development of these ethnic differences is an important priority. Prevention of Type 2 diabetes in British South Asians needs to begin before adult life.     

Increased incidence of end-stage renal failure secondary to diabetes mellitus in Asian ethnic groups in the United Kingdom.

Diabetic renal disease is more common in patients of Asian ethnic origin than White Caucasians in the United Kingdom. This study determines whether a disparity in the incidence of end-stage renal failure secondary to diabetes mellitus exists between these ethnic groups. The incidence of treated end-stage renal failure was estimated using the person-time at risk incidence rate for patients receiving renal replacement therapy secondary to diabetes mellitus in the county of Leicestershire from 1979 to 1988. The incidence rate of end-stage renal failure expressed for the estimated population of patients with diabetes mellitus in patients of Asian ethnic origin was 486.6 (95% CI, 185.1 to 788.1) cases per million person-years per year, compared to 35.6 (17 to 54.2) in White Caucasians. All patients of Asian ethnic origin developing end-stage renal failure had non-insulin-dependent diabetes. The high incidence of end-stage renal failure secondary to diabetes mellitus in patients of Asian ethnic origin in the UK imparts significant public health implications for resource planning and allocation, and the need to initiate strategies to ameliorate renal disease in this ethnic group.     

Evidence of an increasing prevalence of diagnosed diabetes mellitus in the Poole area from 1983 to 1996

This study examined the prevalence of diagnosed diabetes mellitus in a defined population over 13 years by undertaking cross-sectional surveys on 3 occasions between 1983 and 1996. The study population consisted of all the people registered with 10 general (primary care) practices at the time of each survey; 90 660 in 1983/4; 97 122 in 1988/9; and 86 287 in 1996. Ascertainment of cases was by a surveillance programme in general practice and the hospital diabetes department. The number of diabetic patients increased significantly over the study period: in 1983/4, there were 917 patients, crude prevalence 1.01 % (95 % CI 0.95–1.08 %); in 1988/9, 1150 patients, crude prevalence 1.17 % (1.12–1.25 %); and in 1996, 1604 patients, crude prevalence 1.86 % (1.77–1.95 %). The prevalence adjusted to the age and sex distribution of the UK was 0.97 % (95 % CI 0.90–1.03 %) in 1983/4, 1.05 % (0.99–1.11 %) in 1988/9 and 1.55 % (1.48–1.63 %) in 1996. The main increase in prevalence was due to Type 2 diabetes mellitus, crude prevalence 0.75 % (95 % CI 0.69–0.81 %) in 1983/4, 0.92 % (0.86–0.98 %) in 1988/9 and 1.52 % (1.44–1.60 %) in 1996 rather than Type 1 diabetes mellitus, crude prevalence 0.25 % (0.21–0.28 %) in 1983/4, 0.25 % (0.22–0.28 %) in 1988/9 and 0.34 % (0.30–0.38 %) in 1996. During the study period, the crude prevalence of diagnosed diabetes was significantly greater in men than women; in 1983/4 men 1.1 % (95 % CI 1.00–1.20 %) versus women 0.93 % (0.84–1.02 %); in 1988/9, men 1.31 % (1.21–1.41 %) versus women 1.07 % (0.98–1.16 %); and in 1996, men 2.13 % (2.00–2.27 %) versus women 1.60 % (1.49–1.72 %). This difference was statistically significant in the 1988/9 and 1996 surveys. In conclusion, over 13 years there was a significant increase of 83.6 % in the prevalence of diagnosed diabetes mellitus in the Poole area, with the UK age and sex adjusted prevalence increasing by 60.7 %. Copyright © 1998 John Wiley & Sons, Ltd.     

The Poole Diabetes Study: how many cases of Type 2 diabetes are diagnosed each year during normal health care in a defined community?

We have investigated the incidence of newly diagnosed Type 2 diabetes in the Poole area and extrapolated it to the rest of the UK. METHODS: this prospective observational study used a surveillance programme in primary and secondary care. We identified all cases of newly diagnosed Type 2 diabetes mellitus occurring from 1st May 1996 to 30th June 1998 through the normal health care process without any active screening in 186889 people registered with 24 primary care practices in the Poole area. RESULTS: the 1996 prevalence of diagnosed Type 2 diabetes in this population was 1.59 (95% CI 1.53-1.65%)%. During the first 24 months of the study, 706 new cases of Type 2 diabetes mellitus, 382 men and 324 women, were identified. The crude annual incidence of newly diagnosed Type 2 diabetes, thus was 1.93/1000 (95% CI 1.73-2.13%) and age/sex adjusted incidence was 1.67/1000 (95% CI 1.49-1.84%). The age-adjusted incidence was higher in men, 1.86/1000 (95% CI 1.60-2.13), than in women, 1.48/1000 (95% CI 1.25-1.71%), relative risk 1.26 (95% CI 0.997-1.527%), but this difference did not reach statistical significance. Mean HbA1c at diagnosis was 10.8 (S.D. 2.9%)%. Men were younger at diagnosis than women (mean age, 62.9 vs. 65.9%, P<0.01). CONCLUSION: in UK, prior to the change in the WHO diagnostic criteria for diabetes, we estimate that over 98000 new cases of Type 2 diabetes were diagnosed each year.     

Is having a family history of type 2 diabetes or cardiovascular disease a predictive factor for metabolic syndrome?

AimsTo determine whether a first degree family history (FH) of diabetes and/or a first degree FH of cardiovascular disease (CVD), can predict prevalent cases of metabolic syndrome (MetS). Also, to establish if the association is different for South Asians compared to White Europeans, and for obese compared to non-obese individuals.MethodsCross-sectional data were analysed for a mixed-ethnic cohort of 3094 at-risk individuals, aged 40–75 years (29% South Asian), who were screened in Leicestershire (UK) for undiagnosed type 2 diabetes using an oral glucose tolerance test. Logistic regression was used to assess the relationship between FH and prevalent MetS, including adjustment for potential confounders.ResultsPrevalence of MetS was 39%. Adjusted odds ratios (OR) showed that only a FH of CVD (OR 1.41, 95%CI: 1.18–1.68, p < 0.001) was significantly associated with prevalent MetS. Interaction analysis showed no effect modification for obesity and ethnicity. We did not find any association for a FH of diabetes.ConclusionsThese findings suggest that a first degree FH of CVD predicts prevalent cases of MetS in a mixed-ethnic population. Evidence of an association may help to identify individuals who should be targeted for screening and early prevention of type 2 diabetes and CVD.     

Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey,London, UK

Over 20 % of middle aged and elderly South Asian people throughout the world have diabetes. The associated mortality and morbidity risks are unclear. We compared mortality and morbidity in a cohort of South Asian and European people with diabetes in London, UK, in an 11-year follow-up of a population-based sample of 730 South Asians (mean age 55 in 1984) and 304 Europeans (mean age 67 in 1984) with diabetes aged 30 years and above in 1984. By 1995, 242 (33 %) of South Asians, and 172 (57 %) of Europeans had died. The all-cause mortality rate ratio (South Asian versus European) was 1.50 (95 % CI 0.72–3.12) for those aged 30–54 years at baseline. Ethnic differences in mortality rates were abolished or reversed in people aged 65 years and above at baseline. The mortality rate ratio for circulatory deaths was 1.80 (95 % CI 1.03–3.16, p < 0.05) and for heart disease was 2.02 (95 % CI 1.04–3.92, p < 0.05) in those aged 30–64 years at baseline. Seventy-seven per cent of South Asian deaths were caused by circulatory disease, compared with 46 % of European deaths. South Asian survivors were 3.8 times (95 % CI 1.8–8.0, p = 0.001) more likely to report a history of myocardial infarction than Europeans. South Asian adults with diabetes show a markedly increased predisposition to cardiovascular disease compared with Europeans, especially in younger people. This emphasizes the urgent need to reduce cardiovascular risk in this vulnerable group. © 1998 John Wiley & Sons, Ltd.     

Cow's Milk and Type 1 Childhood Diabetes: No Increase in Risk

A retrospective case-control study was undertaken to investigate the relationship between the early introduction of cow's milk and the subsequent risk of developing Type 1 diabetes (< 15 years at diagnosis). A total of 268 children who developed diabetes during the period 1980–1990 (11 years inclusive) in Leicestershire were identified. Age-, sex-, and race-matched controls were identified using the Leicestershire population register. Parents of children with diabetes and their controls completed a structured questionnaire on infant feeding habits from birth. A total of 184 questionnaires (67%) were analysed. There was no difference between the diabetic and control children with respect to the introduction of cow's milk at an early age and the risk of developing diabetes (odds ratio: 0.98 (0.65–1.47)). In addition, short duration of breast-feeding (< 3 months) had no influence on the incidence of diabetes (1.05 (0.64–1.75)). This study does not support the hypothesis that the early introduction of cow's milk or a short duration of breast-feeding increases the risk of developing Type 1 diabetes.     

Parity, ethnic group and the prevalence of type 2 diabetes: the Coventry Diabetes Study.

The prevalence of Type 2 (non-insulin-dependent diabetes) in relation to parity was compared among South Asian (Asian) and European women during a cross-sectional house-to-house screening programme for diabetes in Foleshill, Coventry, UK. The parity of female residents was ascertained in 8 of the 12 areas visited. These areas contained 2096 European (68 with diabetes diagnosed) and 1148 Asian women (95 with diabetes diagnosed). Crude prevalence of Type 2 diabetes was 3.2% and 14.7% in Europeans aged 30-64 years and > or = 65 years, respectively, and 10.9% and 36.5% in similarly aged Asians, respectively. In those aged 30-64 years, the age and body mass index adjusted prevalence of Type 2 diabetes was highest among nulliparous (Europeans 4.4%, Asians 16.3%) and grand multiparous (parity > or = 5: Europeans 6.3%, Asians 16.5%) women when compared with women who had had 1 or 2 deliveries (Europeans 0.9%, Asians 3.3%, p < 0.001, both ethnic groups). However, parity had no effect among women aged > or = 65 years.     

High prevalence of gestational diabetes in women from ethnic minority groups.

The influence of ethnic origin, body mass index, and parity on the frequency of gestational diabetes was assessed in 11,205 consecutive women attending a multiracial antenatal clinic in London, where all women were screened for gestational diabetes. Logistic regression was used to model the relationship between gestational diabetes and ethnic origin, age, body mass index (BMI), and parity. Results were presented as adjusted odds ratios, where the reference categories are White women, age < 25 years, BMI < 27, and parity < 3. Ethnic origin was the dominant influence on the prevalence of gestational diabetes. Women from ethnic groups other than White had a higher frequency of gestational diabetes than White women (2.9% vs 0.4%, p < 0.001). Compared to White women the relative risk of gestational diabetes in the other ethnic groups was: Black 3.1 (95% confidence limits 1.8-5.5), South East Asian 7.6 (4.1-14.1), Indian 11.3 (6.8-18.8), and miscellaneous 5.9 (3.5-9.9). Increasing age was an independent risk factor. The relative risk was higher in women > or = 35 years in all ethnic groups other than in South East Asian women. Obesity (BMI > or = 27) was a further independent risk factor in all ethnic groups except in the Indian and South East Asian women. Parity > or = 3 increased the relative risk of gestational diabetes in the White, Black, and South East Asian women only.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diabetes Care in South Asian and White European Patients with Type 2 Diabetes

Aspects of diabetes care in South Asian and white European patients with Type 2 diabetes attending a hospital review clinic were explored. Among the clinic population of 1710 patients, 25B (15%) were of South Asian origin. A significantly greater proportion (95% CI for difference in proportions 8–22%) of these patients was treated with oral hypoglycaemic drugs than in white Europeans, in whom there was a correspondingly greater proportion receiving insulin treatment. In a case-control study, where 154 patients in each racial group were stratified according to treatment regimen, significantly more South Asian patients (13/30 vs 6/30, p < 0.05) on insulin were treated with a once-daily regimen. Despite these observed differences in treatment of diabetes, glycaemic control was no worse in South Asian patients when compared to their white European counterparts. South Asian diabetic patients attending hospital diabetes clinics in the UK can experience similar levels of glycaemic control to white Europeans.     

Prevalence,incidence, survival,and disease characteristics of systemic sclerosis in a large US population

Objective

To estimate the prevalence, incidence, survival, and disease characteristics of systemic sclerosis (SSc) in the Detroit tricounty area.

Methods

A census of SSc cases for the period 1989–1991 was conducted in the Detroit area, using multiple sources for case identification. Diagnoses were verified by medical record review. Capture‐recapture analysis was used to estimate the total SSc population. Cases of localized scleroderma (morphea and linear disease) were excluded.

Results

Based on 706 verified cases of SSc, prevalence was initially estimated to be 242.0 cases per million adults (95% confidence interval [95% CI] 213–274), with an annual incidence of 19.3 new cases per million adults per year (95% CI 12.4–30.2). Capture‐recapture analysis, based on the degree of overlap of verified cases among multiple sources, resulted in a revised prevalence estimate of 276 cases per million adults (95% CI 245–310). Sex‐ and race‐specific prevalence estimates were significantly higher for women than for men, and for blacks than for whites. The average age at diagnosis was significantly younger for blacks than for whites. Compared with white patients, black patients were almost twice as likely to have diffuse disease (prevalence proportion ratio 1.86, 95% CI 1.48–2.35). Median survival was ∼11 years. Factors negatively affecting survival included male sex (hazard ratio 1.81, 95% CI 1.29–2.55) and older age at diagnosis (hazard ratio 1.04, 95% CI 1.03–1.05).

Conclusion

This study establishes baseline estimates of SSc occurrence and characteristics in a large US cohort consisting primarily of black adults and white adults. These data should facilitate research regarding the role of geographic, ethnic, racial, and environmental factors for this disease in comparison populations.

     

Epidemiology of Diabetes in Bucharest

An analysis of the last 20 000 newly diagnosed diabetic patients consecutively registered from 1 January 1981 to 6 June 1991 in the Bucharest Registry of Diabetes showed the following: (1) primary insulin-dependence (Type 1 diabetes) was encountered in only 7% of cases: the rest were Type 2 diabetic patients (8745:43.7% treated with diet alone and 9856:49.3% treated with diet and oral drugs); (2) low body weight (BMI < 25) was encountered in 81.7% of patients in the age group 0–20 years, while obesity (BMI > 27) was encountered in 75.7% of cases in the age group 41–65 years; (3) the overall annual incidence of the Type 1 diabetes for all ages was 5.7/100 000, lowest (1.3/100 000) in the age group 0–4 years and the highest 10.1/100 000) in the age group 65–69 years; (4) the overall annual incidence for the Type 2 diabetes was 76.3/100 000, the lowest (2.4/100 000) in the age group 20–24 years and the highest (261.4/100 000) in the age group 60–64 years. Studying the relationship between the onset of Type 1 diabetes mellitus and age, we did not observe the previously reported strong relationship, so that the distribution of Type 1 diabetes can be considered relatively uniform, with the exception of extreme ages. In conclusion, each year, about 1 in 1000 inhabitants of Bucharest are registered as having diabetes, the majority (93%) had type 2 and only 7% had Type 1 diabetes, one of the lowest incidence rates in Europe.     

Body mass index in young adulthood and mid-life cardiovascular risk factors in South Asian American adults: The MASALA study

The association of self-reported BMI at age 20, at age 40, the highest BMI within the past 3 years, and current BMI with current mid-life cardiovascular risk factors and coronary artery calcium (CAC) was evaluated among 1148 South Asian American participants (mean age 57 years) in the MASALA study. A 1 kg/m² higher BMI at age 20 was associated with higher odds of hypertension (aOR 1.07, 95% CI 1.03–1.12), pre-diabetes/diabetes (aOR 1.05 [1.01–1.09]), and prevalent CAC (aOR 1.06 [1.02–1.11]) in mid-life. Associations were similar for all BMI measures. Weight across young adulthood is associated with mid-life cardiovascular health in South Asian American adults.     

Comparison of prevalence and risk factors for microalbuminuria in South Asians and Europeans with Type 2 diabetes mellitus

Although Type 2 (non-insulin-dependent) diabetes mellitus (Type 2 DM) is more common in South Asians than in Europeans in the UK, very little is known about complications and their risk factors in South Asians. We sought microalbuminuria in a cross-sectional study of 583 European and 889 South Asian Type 2 DM clinic attenders to Ealing Hospital, London, over 1 year. Albumin/creatinine ratios were measured in early morning urines. Prevalence of microalbuminuria was greater in South Asians compared to Europeans (40 % versus 33 % in men, p = 0.003, and 33 % versus 19 % in women, p < 0.0001). Glycaemic control was worse and prevalence of hypertension, retinopathy and heart disease was higher in South Asians. Key risk factors for microalbuminuria in both ethnic groups were glycaemic control, diabetes duration, blood pressure, triglyceride and retinopathy, but none accounted for the higher microalbuminuria prevalence in South Asians. Age and sex adjusted odds ratio for microalbuminuria was 1.78 (95 % CI 1.02, 2.82, p = 0.02) in South Asians versus Europeans. After adjustment for confounders, this became 2.07, 95 % CI 1.13, 3.79, p = 0.02. We conclude that microalbuminuria is more common in South Asians with Type 2 DM than in Europeans and, although risk factor relationships appeared similar in both groups, and some risk factors were more prominent in South Asians, this cannot account for the high prevalence of microalbuminuria observed in South Asians. © 1998 John Wiley & Sons, Ltd.     

Asian MODY: are we missing an important diagnosis?

AIMS: Maturity onset diabetes of the young (MODY) is a monogenic form of diabetes where correct diagnosis alters treatment, prognosis and genetic counselling. The first UK survey of childhood MODY identified 20 White, but no Asian children with MODY. We hypothesized that MODY causes diabetes in UK Asians, but is underdiagnosed. METHODS: Children with dominant family histories of diabetes were recruited. Direct sequencing for mutations in the two most common MODY genes; HNF1A (TCF1) and GCK was performed in autoantibody-negative probands. We also compared MODY testing data for Asian and White cases from the Exeter MODY database, to 2001 UK census data. RESULTS: We recruited 30 families and identified three Asian families with MODY gene mutations (two HNF1A, one GCK) and three White UK families (two HNF1A, one GCK). Heterozygous MODY phenotypes were similar in Asians and Whites. Only eight (0.5%) of 1369 UK referrals for MODY testing were known to be Asian, but in 2001 Asians represented 4% of the English/Welsh population and have a higher prevalence of diabetes. CONCLUSIONS: We identified three cases of childhood MODY in UK Asians and demonstrated reduced rates of MODY testing in Asians, which has negative implications for treatment. It is unclear why this is. MODY should be considered in autoantibody-negative Asian diabetes patients lacking evidence of insulin resistance.     

Trends in Mortality of Childhood-onset Insulin-dependent Diabetes Mellitus in Leicestershire: 1940–1991

The relative risk of death by calendar date of diagnosis was investigated in a population-based incident cohort of 845 (463 males:382 females) IDDM diagnosed in Leicestershire before the age of 17 years between 1940 and 1989. The mortality status of 844 (99.9 %) patients was determined as of the 31 December 1991, representing 14 346 person-years of risk. Trends in relative risk of death were investigated using Cox proportional hazards modelling for within cohort comparisons and age/sex and calendar time adjusted standardized mortality ratios (SMR) using generalized linear modelling for external comparisons. Median age at diagnosis was 10 years (range 3 months to 16 years); median duration of diabetes 15 years (range 1–51 years). Forty-four patients had died (5.2 %; median age at death 31 years, range 11–51 years). A further four patients died at presentation (within 24 h) from ketoacidosis and are excluded from all analyses. Calendar date of diagnosis was found to be an important predictor of mortality. Adjusting for attained age there was evidence of a decline in relative risk of death with calendar date of diagnosis of 3.4 % (95 % CI, 0.005–6.9 %) per annum, equivalent to a 32 % fall per decade (95 % CI, 5–51 %), or 84 % (95 % CI, 21–97) from 1940 to 1989. The data are consistent with a large fall in mortality between the 1940s and 1950s representing over 50 % of the total reduction in mortality between 1940 and 1991. Neither sex nor age at diagnosis were significant predictors of mortality. Over the study period 1940–89 the SMR (male and female combined) fell from 981 (541–1556) to 238 (60–953) relative to the general population. This population-based study shows that the prognosis for Type 1 (insulin-dependent) diabetes mellitus has improved markedly over the period 1940–1991.     

Australia’s national trends in the incidence of Type 1 diabetes in 0–14‐year‐olds, 2000–2006

Aims To determine the national incidence of Type 1 diabetes in children aged 0–14 years and examine trends in incidence between 2000 and 2006 by age, sex and calendar year. Methods Case ascertainment was from the Australian National Diabetes Register, a prospective population‐based incidence register established in 1999, with two sources of ascertainment: the National Diabetes Services Scheme and the Australasian Paediatric Endocrine Group’s state‐based registers. Denominator data were from the Australian Bureau of Statistics. Results There were 6350 new cases of Type 1 diabetes (3323 boys and 3027 girls). Case ascertainment was 97.1% complete using the capture–recapture method. The mean adjusted incidence rate for 2000–2006 was 21.6 per 100 000 person‐years [95% confidence interval (CI) 21.0, 22.1], and increased from 19.8 in 2000 to 23.4 per 100 000 in 2006, an average increase of 2.8% (95% CI 1.5, 4.1) per year. Mean incidence for the 7‐year period increased with age, and was significantly higher in boys aged 0–4 years and 10–14 years than in girls of the same age. Conclusions The incidence of Type 1 diabetes among 0–14‐year‐olds in Australia is very high compared with available data from many other countries. The rate of increase observed globally in the last decade has continued well into this decade in Australia. The rising incidence cannot be explained by changes in genetic susceptibility; there is an urgent need to examine the environmental factors that have contributed to this increase. The findings of this study also have important implications for resource planning.     

Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states

Background: Despite evidence-based prevention and practice guidelines, asthma prevalence, treatment, and outcomes vary widely at individual and community levels. Asthma disproportionate/ly affects low-income and minority children, who comprise a large segment of the Medicaid population. Methods: 2007 Medicaid claims data from 14 southern states was mapped for 556 counties to describe the local area variation in 1-year asthma prevalence rates, emergency department (ED) visit rates, and racial disparity rate ratios. Results: One-year period prevalence of asthma ranged from 2.8% in Florida to 6.4% in Alabama, with a median prevalence rate of 4.1%. At the county level, the prevalence was higher for Black children and ranged from 1.03% in Manatee County, FL, to 21.0% in Hockley County, TX. Black–White rate ratios of prevalence ranged from 0.49 in LeFlore County, MS, to 3.87 in Flagler County, FL. Adjusted asthma ED visit rates ranged from 2.2 per 1000 children in Maryland to 16.5 in Alabama, with a median Black–White ED-visit rate ratio of 2.4. Rates were higher for Black children, ranging from 0.80 per 1000 in Wicomico County, MD, to 70 per 1000 in DeSoto County, FL. Rate ratios of ED visits ranged from 0.25 in Vernon Parish, LA, to 25.28 in Nelson County, KY. Conclusions and relevance: Low-income children with Medicaid coverage still experience substantial variation in asthma prevalence and outcomes from one community to another. The pattern of worse outcomes for Black children also varies widely across counties. Eliminating this variation could substantially improve overall outcomes and eliminate asthma disparities.