Large incidence variation of Type I diabetes in central-southern Italy 1990-1995: lower risk in rural areas

Geographical variation of presentation at diagnosis of Type I diabetes in children: the EURODIAB Study

“…The frequency of DKA might be lower in countries with a more prosperous lifestyle and with a more organized and efficient health care system. The most recent data produced by our network suggest that indicators of wealth are strongly associated with incidence rates across Europe [31,32]. The inverse relation between incidence rates and proportions of children with ketoacidosis is consistent with a high level of medical awareness which increases the chances of early diagnosis and consequently reduces the risk of ketoacidosis.…”

Higher incidence of childhood-onset type 1 diabetes mellitus in remote areas: a UK regional small-area analysis

“…In addition, a number of small-area studies have detected higher incidence rates in rural areas [2,7], broadly in agreement with our results. In contrast to the Northern Ireland findings, two studies detected lower rates in rural areas in Italy [6] and Lithuania [8]. The contradictory associations noted in Italy and Lithuania may reflect a different rural lifestyle in these countries.…”

“…A theory, referred to as the hygiene hypothesis, suggests that reduced or delayed exposure to infections, particularly early in life, may increase the possibility of an abnormal immune response increasing the risk of type 1 diabetes mellitus [1]. Previous ecological analyses of type 1 diabetes mellitus have examined variations in incidence rates in relation to area characteristics which are likely to be associated with exposure to infections such as deprivation [2][3][4], child population density [3][4][5] and urban-rural status [2,[6][7][8]. Only one study [9] has investigated the association between type 1 diabetes and remoteness (another proxy measure for exposure to infections) but in that study remoteness was measured primarily using population density.…”

Bayesian analysis of geographical variation in the incidence of Type I diabetes in Finland

“…A lower incidence of childhood diabetes among children living in urban areas has been reported in England [22]. On the other hand, findings reported in Italy suggested that people living in the rural communities had a lower risk of Type I diabetes [24]. Thus it seems that the degree of urbanization might not have an effect on the risk for Type I diabetes.…”