Increase in the incidence of type 1 diabetes in Israeli children following the Second Lebanon War

• Published in: Pediatric diabetes Vol. 13; no. 4; pp. 326 - 333
• Main Authors: Zung, Amnon, Blumenfeld, Orit, Shehadeh, Naim, Dally Gottfried, Orna, Tenenbaum Rakover, Yardena, Hershkovitz, Eli, Gillis, David, Zangen, David, Pinhas-Hamiel, Orit, Hanukoglu, Aaron, Rachmiel, Marianna, Shalitin, Shlomit
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.06.2012
• Subjects: Adolescent; Child; Child, Preschool; children; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - etiology; Female; Humans; Incidence; Infant; Israel - epidemiology; Male; psychological stress; Seasons; Stress Disorders, Post-Traumatic; Stress, Psychological - complications; Stress, Psychological - epidemiology; type 1 diabetes; war; Warfare; Israel
• ISSN: 1399-543X; 1399-5448
• DOI: 10.1111/j.1399-5448.2011.00838.x

Background Type 1 diabetes is an autoimmune disease occurring in genetically susceptible individuals. The precipitating cause is unclear. Recently, the Second Lebanon War exposed a large civilian population in northern Israel to significant psychological stress in the form of repeated barrages of missile attacks. Hypothesis We hypothesized that trends in regional incidence of type 1 diabetes before and after the war would reflect an association with stress. Methods All type 1 diabetes patients aged 0–17 yr who were reported to the Israel Juvenile Diabetes Register (n = 1822) in the four pre‐war (2002–2005) and two post‐war years (2006–2007) were included in the study. The patients were stratified by gender, age, ethnicity, family history of type 1 diabetes, season at diagnosis, and region of residency, namely, those who lived in the northern regions that were attacked and those in other regions. Results The post‐war incidence of type 1 diabetes was increased in the northern regions (rate ratio, RR = 1.27; p = 0.037), with no change in the other regions. This change was more prominent in males (RR = 1.55; p = 0.005) but similar in summer and winter, in different ages, and in different ethnic groups. There was no change in the proportion of new patients with a family history of the disease. Conclusions For the first time in a large population, we found a positive association between the trauma of war and an increase in the incidence of type 1 diabetes in children and adolescents. The increase in incidence was not associated with genetic susceptibility to the disease.