Context and disease when disease risk is low: the case of type 1 diabetes in Sweden
Lynch, Kristian LU ; Subramanian, S. V. ; Ohlsson, Henrik LU ; Chaix, Basile LU ; Lernmark, Åke LU
and Merlo, Juan
LU
(2010)
In Journal of Epidemiology and Community Health
64(9).
p.789-795
- Abstract
- Background Several European studies have found significant small area variation in the risk of childhood onset (type 1) diabetes (T1D) which has been interpreted as evidence for contextual determinants of T1D. However, this conclusion may be fallacious since the limited number of newborn infants and the low risk for T1D is a source of spurious variability not properly handled by usual statistical methods. This study investigates the existence of contextual effects in the genesis of T1D, compares conclusions in previous reports with results obtained in a multilevel regression framework and highlights analysis of variance as a useful approach in public health. Methods All singletons born in Sweden between 1987 and 1991 were identified in the... (More)
- Background Several European studies have found significant small area variation in the risk of childhood onset (type 1) diabetes (T1D) which has been interpreted as evidence for contextual determinants of T1D. However, this conclusion may be fallacious since the limited number of newborn infants and the low risk for T1D is a source of spurious variability not properly handled by usual statistical methods. This study investigates the existence of contextual effects in the genesis of T1D, compares conclusions in previous reports with results obtained in a multilevel regression framework and highlights analysis of variance as a useful approach in public health. Methods All singletons born in Sweden between 1987 and 1991 were identified in the Medical Birth Registry (n=560 766) and followed for diabetes until age 14 using the Hospital Discharge Registry. Area variation in the cumulative incidence of T1D was estimated by different statistical methods including multilevel logistic regression. Results The risk of T1D ranged from 4.3 to 6.5 per 1000 newborns across the counties (n=24) and from 0.0 to 19.2 per 1000 newborns across the municipalities (n=284). These differences were significant in standard statistical tests (counties, p=0.02; municipalities, p=0.007). However, according to multilevel analyses, the risk of T1D ranged from 4.7 to 5.7 and from 4.4 to 6.0 per 1000 newborns in counties and municipalities, respectively, and the area variation was small and without practical relevance (counties, sigma(2)=0.006; municipalities, sigma(2)=0.017). Conclusions Previous reports based on standard statistical tests are misleading. According to multilevel analysis, administrative areas have minor relevance for individual risk of T1D in Sweden. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1673090
- author
- Lynch, Kristian
LU
; Subramanian, S. V.
; Ohlsson, Henrik
LU
; Chaix, Basile
LU
; Lernmark, Åke
LU
and Merlo, Juan
LU
- organization
- publishing date
- 2010
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Epidemiology and Community Health
- volume
- 64
- issue
- 9
- pages
- 789 - 795
- publisher
- BMJ Publishing Group
- external identifiers
-
- wos:000281308900011
- scopus:77957252997
- pmid:19833608
- ISSN
- 1470-2738
- DOI
- 10.1136/jech.2008.083667
- language
- English
- LU publication?
- yes
- id
- 329c6314-6651-46c4-bfd4-c7538b03a160 (old id 1673090)
- date added to LUP
- 2016-04-01 10:51:06
- date last changed
- 2022-01-26 03:01:04
@article{329c6314-6651-46c4-bfd4-c7538b03a160,
abstract = {{Background Several European studies have found significant small area variation in the risk of childhood onset (type 1) diabetes (T1D) which has been interpreted as evidence for contextual determinants of T1D. However, this conclusion may be fallacious since the limited number of newborn infants and the low risk for T1D is a source of spurious variability not properly handled by usual statistical methods. This study investigates the existence of contextual effects in the genesis of T1D, compares conclusions in previous reports with results obtained in a multilevel regression framework and highlights analysis of variance as a useful approach in public health. Methods All singletons born in Sweden between 1987 and 1991 were identified in the Medical Birth Registry (n=560 766) and followed for diabetes until age 14 using the Hospital Discharge Registry. Area variation in the cumulative incidence of T1D was estimated by different statistical methods including multilevel logistic regression. Results The risk of T1D ranged from 4.3 to 6.5 per 1000 newborns across the counties (n=24) and from 0.0 to 19.2 per 1000 newborns across the municipalities (n=284). These differences were significant in standard statistical tests (counties, p=0.02; municipalities, p=0.007). However, according to multilevel analyses, the risk of T1D ranged from 4.7 to 5.7 and from 4.4 to 6.0 per 1000 newborns in counties and municipalities, respectively, and the area variation was small and without practical relevance (counties, sigma(2)=0.006; municipalities, sigma(2)=0.017). Conclusions Previous reports based on standard statistical tests are misleading. According to multilevel analysis, administrative areas have minor relevance for individual risk of T1D in Sweden.}},
author = {{Lynch, Kristian and Subramanian, S. V. and Ohlsson, Henrik and Chaix, Basile and Lernmark, Åke and Merlo, Juan}},
issn = {{1470-2738}},
language = {{eng}},
number = {{9}},
pages = {{789--795}},
publisher = {{BMJ Publishing Group}},
series = {{Journal of Epidemiology and Community Health}},
title = {{Context and disease when disease risk is low: the case of type 1 diabetes in Sweden}},
url = {{http://dx.doi.org/10.1136/jech.2008.083667}},
doi = {{10.1136/jech.2008.083667}},
volume = {{64}},
year = {{2010}},
}