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Incidence of Type 1 Diabetes in Philadelphia Is Higher in Black Than White Children From 1995 to 1999

Epidemic or misclassification?

¹ University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
² Division of Endocrinology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
³ Division of Biostatistics and Epidemiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
⁴ Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
⁵ Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
⁶ Section of Endocrinology, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
⁷ Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Terri H. Lipman, PhD, CRNP, University of Pennsylvania School of Nursing, 420 Guardian Dr., Philadelphia, PA 19104. E-mail: lipman{at}nursing.upenn.edu

OBJECTIVE—To determine the epidemiology of type 1 diabetes in children in Philadelphia, Pennsylvania, from 1995 through 1999 and compare these data with previous cohorts.

RESEARCH DESIGN AND METHODS—This is a report of a retrospective population-based registry maintained since 1985. Hospital records meeting the following criteria were reviewed: newly diagnosed type 1 diabetes, age 0–14 years, residing in Philadelphia at the time of diagnosis, and diagnosed from 1 January 1995 to 31 December 1999. The secondary source of validation was the School District of Philadelphia. Incidence rates by race and age were compared with 1985–1989 and 1990–1994 cohorts.

RESULTS—A total of 234 case subjects were identified, and the registry was determined to be 96% complete. The overall age-adjusted incidence rate in Philadelphia was 14.8 per 100,000/year. Incidence rates in Hispanic children (15.5 per 100,000/year) and white children (12.8 per 100,000/year) have been relatively stable over 15 years. The incidence in black children (15.2 per 100,000/year), however, has increased dramatically, rising 64% in children 5–9 years of age (14.9 per 100,000/year) and 37% in the 10- to 14-year age-group (26.9 per 100,000/year).

CONCLUSIONS—The overall incidence of type 1 diabetes in Philadelphia is increasing and is similar to other U.S. registries. These are the first data reporting a higher incidence in black children in a registry of children 0–14 years of age. The etiology of the marked increase in incidence in the black population is unknown and underscores the need to establish type 1 diabetes as a reportable disease, so that environmental risk factors may be thoroughly investigated.

Abbreviations: WHO, World Health Organization

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