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Geospatial clustering of type 1 diabetes in Sweden : a cohort study based on all residential locations from birth to diagnosis

Sebraoui, Samy ; Englund, Oskar ; Nyberg, Fredrik ; Carlsson, Annelie LU orcid ; Korsgren, Olle ; Forsander, Gun ; Eeg-Olofsson, Katarina ; Eliasson, Björn ; Carlsen, Hanne K. and Åkesson, Karin LU , et al. (2026) In Diabetologia
Abstract

Aims/hypothesis: Type 1 diabetes develops gradually, and previous exposures may influence incidence. We aimed to assess the geographical variation in type 1 diabetes incidence in Sweden by considering all residential locations from birth to diagnosis in individuals aged 0–30 years, diagnosed between 2005 and 2022. Significant high- and low-risk clusters were identified for different life stage exposure windows. Methods: In 21,774 individuals with type 1 diabetes, all residential geographical locations from birth to diagnosis were geocoded. Geostatistical analysis of the incidence of type 1 diabetes was conducted at the municipality level using the most common residential location during four life stage-specific exposure windows (at... (More)

Aims/hypothesis: Type 1 diabetes develops gradually, and previous exposures may influence incidence. We aimed to assess the geographical variation in type 1 diabetes incidence in Sweden by considering all residential locations from birth to diagnosis in individuals aged 0–30 years, diagnosed between 2005 and 2022. Significant high- and low-risk clusters were identified for different life stage exposure windows. Methods: In 21,774 individuals with type 1 diabetes, all residential geographical locations from birth to diagnosis were geocoded. Geostatistical analysis of the incidence of type 1 diabetes was conducted at the municipality level using the most common residential location during four life stage-specific exposure windows (at diagnosis, the first 5 years after birth, 5 years prior to diagnosis, and from birth to diagnosis). Spatial scan statistics were used to identify statistically significant high- and low-risk clusters for each window. Land use and land cover within these clusters were also characterised. Results: Significant geographical variation in the incidence of type 1 diabetes was observed. The incidence was consistently higher in rural, low-population-density areas, particularly in central Sweden, and lower in major urban areas. The largest number of spatial clusters of both high risk (RR 1.29–16.0) and low risk (RR 0.32–0.73) was identified when using the most common residential location during the first 5 years after birth. High-risk clusters for this exposure window were characterised by forested and agricultural land, while low-risk clusters were characterised by urban land and open land other than agricultural land. Conclusions/interpretation: Our findings suggest that the development of type 1 diabetes in Sweden varies geographically and is associated with specific features of the local surroundings in early childhood. This is important knowledge as a basis for identifying possible environmental risk factors and the relationship with risk of type 1 diabetes in future studies.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Disease mapping, Environment-wide association study, Environmental exposures, Epidemiology, Geographical variation, Incidence, Risk factors, Space-time clustering, Type 1 diabetes
in
Diabetologia
publisher
Springer
external identifiers
  • pmid:41692841
  • scopus:105030151503
ISSN
0012-186X
DOI
10.1007/s00125-026-06675-9
language
English
LU publication?
yes
id
afa364fe-7543-4a84-8a55-757c86636d86
date added to LUP
2026-03-02 13:12:26
date last changed
2026-06-02 03:00:19
@article{afa364fe-7543-4a84-8a55-757c86636d86,
  abstract     = {{<p>Aims/hypothesis: Type 1 diabetes develops gradually, and previous exposures may influence incidence. We aimed to assess the geographical variation in type 1 diabetes incidence in Sweden by considering all residential locations from birth to diagnosis in individuals aged 0–30 years, diagnosed between 2005 and 2022. Significant high- and low-risk clusters were identified for different life stage exposure windows. Methods: In 21,774 individuals with type 1 diabetes, all residential geographical locations from birth to diagnosis were geocoded. Geostatistical analysis of the incidence of type 1 diabetes was conducted at the municipality level using the most common residential location during four life stage-specific exposure windows (at diagnosis, the first 5 years after birth, 5 years prior to diagnosis, and from birth to diagnosis). Spatial scan statistics were used to identify statistically significant high- and low-risk clusters for each window. Land use and land cover within these clusters were also characterised. Results: Significant geographical variation in the incidence of type 1 diabetes was observed. The incidence was consistently higher in rural, low-population-density areas, particularly in central Sweden, and lower in major urban areas. The largest number of spatial clusters of both high risk (RR 1.29–16.0) and low risk (RR 0.32–0.73) was identified when using the most common residential location during the first 5 years after birth. High-risk clusters for this exposure window were characterised by forested and agricultural land, while low-risk clusters were characterised by urban land and open land other than agricultural land. Conclusions/interpretation: Our findings suggest that the development of type 1 diabetes in Sweden varies geographically and is associated with specific features of the local surroundings in early childhood. This is important knowledge as a basis for identifying possible environmental risk factors and the relationship with risk of type 1 diabetes in future studies.</p>}},
  author       = {{Sebraoui, Samy and Englund, Oskar and Nyberg, Fredrik and Carlsson, Annelie and Korsgren, Olle and Forsander, Gun and Eeg-Olofsson, Katarina and Eliasson, Björn and Carlsen, Hanne K. and Åkesson, Karin and Gudbjörnsdottir, Soffia}},
  issn         = {{0012-186X}},
  keywords     = {{Disease mapping; Environment-wide association study; Environmental exposures; Epidemiology; Geographical variation; Incidence; Risk factors; Space-time clustering; Type 1 diabetes}},
  language     = {{eng}},
  publisher    = {{Springer}},
  series       = {{Diabetologia}},
  title        = {{Geospatial clustering of type 1 diabetes in Sweden : a cohort study based on all residential locations from birth to diagnosis}},
  url          = {{http://dx.doi.org/10.1007/s00125-026-06675-9}},
  doi          = {{10.1007/s00125-026-06675-9}},
  year         = {{2026}},
}