Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort

Justine Tanoey, Christina Baechle, Hermann Brenner, Andreas Deckert, Julia Fricke, Kathrin Günther, André Karch, Thomas Keil, Alexander Kluttig, Michael Leitzmann, Rafael Mikolajczyk, Nadia Obi, Tobias Pischon, Tamara Schikowski, Sabine M. Schipf, Matthias B. Schulze, Anja Sedlmeier, Ilais Moreno Velásquez, Katharina S. Weber, Henry Völzke, Wolfgang Ahrens, Sylvia Gastell, Bernd Holleczek, Karl-Heinz Jöckel, Verena Katzke, Wolfgang Lieb, Karin B. Michels, Börge Schmidt, Henning Teismann and Heiko Becher ()
Additional contact information
Justine Tanoey: Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Christina Baechle: Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich Heine University, 40225 Düsseldorf, Germany
Hermann Brenner: Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
Andreas Deckert: Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany
Julia Fricke: Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
Kathrin Günther: Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
André Karch: Institute for Epidemiology and Social Medicine, Albert-Schweitzer-Campus 1, Building D3, 48149 Münster, Germany
Thomas Keil: Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
Alexander Kluttig: Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
Michael Leitzmann: Department for Epidemiology and Preventive Medicine, Regensburg University Medical Center, 93053 Regensburg, Germany
Rafael Mikolajczyk: Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
Nadia Obi: Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Tobias Pischon: Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Molecular Epidemiology Research Group, 13125 Berlin, Germany
Tamara Schikowski: Leibniz Research Institute for Environmental Medicine—IUF, 40225 Düsseldorf, Germany
Sabine M. Schipf: Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany
Matthias B. Schulze: German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
Anja Sedlmeier: Department for Epidemiology and Preventive Medicine, Regensburg University Medical Center, 93053 Regensburg, Germany
Ilais Moreno Velásquez: Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Molecular Epidemiology Research Group, 13125 Berlin, Germany
Katharina S. Weber: Institute of Epidemiology, Kiel University, 24105 Kiel, Germany
Henry Völzke: Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany
Wolfgang Ahrens: Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
Sylvia Gastell: German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
Bernd Holleczek: Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
Karl-Heinz Jöckel: Institute of Medical Informatics, Biometry und Epidemiology, Essen University Hospital, 45147 Essen, Germany
Verena Katzke: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
Wolfgang Lieb: Institute of Epidemiology, Kiel University, 24105 Kiel, Germany
Karin B. Michels: Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, 79110 Freiburg, Germany
Börge Schmidt: Institute of Medical Informatics, Biometry und Epidemiology, Essen University Hospital, 45147 Essen, Germany
Henning Teismann: Institute for Epidemiology and Social Medicine, Albert-Schweitzer-Campus 1, Building D3, 48149 Münster, Germany
Heiko Becher: Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany

IJERPH, 2022, vol. 19, issue 17, 1-14

Abstract: (1) Background: Global incidence of type 1 diabetes (T1D) is rising and nearly half occurred in adults. However, it is unclear if certain early-life childhood T1D risk factors were also associated with adult-onset T1D. This study aimed to assess associations between birth order, delivery mode or daycare attendance and type 1 diabetes (T1D) risk in a population-based cohort and whether these were similar for childhood- and adult-onset T1D (cut-off age 15); (2) Methods: Data were obtained from the German National Cohort (NAKO Gesundheitsstudie) baseline assessment. Self-reported diabetes was classified as T1D if: diagnosis age ≤ 40 years and has been receiving insulin treatment since less than one year after diagnosis. Cox regression was applied for T1D risk analysis; (3) Results: Analyses included 101,411 participants (100 childhood- and 271 adult-onset T1D cases). Compared to “only-children”, HRs for second- or later-born individuals were 0.70 (95% CI = 0.50–0.96) and 0.65 (95% CI = 0.45–0.94), respectively, regardless of parental diabetes, migration background, birth year and perinatal factors. In further analyses, higher birth order reduced T1D risk in children and adults born in recent decades. Caesarean section and daycare attendance showed no clear associations with T1D risk; (4) Conclusions: Birth order should be considered in both children and adults’ T1D risk assessment for early detection.

Keywords: perinatal; adult-onset; late-onset; autoimmune; delivery mode; sex; offspring; NAKO (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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