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Global, regional, and national burden of type 1 diabetes in adolescents and young adults
Background
Type 1 diabetes (T1D) incidence in adolescents varies widely, but has increased globally in recent years. This study reports T1D burden among adolescents and young adults aged 10–24-year-old age group at global, regional, and national levels.
Methods
Based on the Global Burden of Disease Study 2019, we described the burden of T1D in the 10–24-year-old age group. We further analyzed these trends by age, sex, and the Social Development Index. Joinpoint regression analysis was used to assess temporal trends.
Results
T1D incidence among adolescents and young adults increased from 7·78 per 100,000 population (95% UI, 5·27–10·60) in 1990 to 11·07 per 100,000 population (95% UI, 7·42–15·34) in 2019. T1D mortality increased from 5701·19 (95% UI, 4642·70–6444·08) in 1990 to 6,123·04 (95% UI, 5321·82–6887·08) in 2019, representing a 7·40% increase in mortality. The European region had the highest T1D incidence in 2019. Middle-SDI countries exhibited the largest increase in T1D incidence between 1990 and 2019.
Conclusion
T1D is a growing health concern globally, and T1D burden more heavily affects countries with low SDI. Specific measures and effective collaboration among countries with different SDIs are required to improve diabetes care in adolescents.
Impact
We assessed trends in T1D incidence and burden among youth in the 10–24-year-old age group by evaluating data from the Global Burden of Disease Study 2019.
Our results demonstrated that global T1D incidence in this age group increased over the past 30 years, with the European region having the highest T1D incidence.
Specific measures and effective collaboration among countries with different SDIs are required to improve diabetes care in adolescents.
Journal Article
Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy
Background
In southern Europe, the risk of cancer in patients with end-stage kidney disease receiving dialysis has not been well quantified. The aim of this study was to assess the overall pattern of risk for de novo malignancies (DNMs) among dialysis patients in the Friuli Venezia Giulia region, north-eastern Italy.
Methods
A population-based cohort study among 3407 dialysis patients was conducted through a record linkage between local healthcare databases and the cancer registry (1998–2013). Person-years (PYs) were calculated from 30 days after the date of first dialysis to the date of DNM diagnosis, kidney transplant, death, last follow-up or December 31, 2013, whichever came first. The risk of DNM, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs).
Results
During 10,798 PYs, 357 DNMs were diagnosed in 330 dialysis patients. A higher than expected risk of 1.3-fold was found for all DNMs combined (95% CI: 1.15–1.43). The risk was particularly high in younger dialysis patients (SIR = 1.88, 95% CI: 1.42–2.45 for age 40–59 years), and it decreased with age. Moreover, significantly increased DNM risks emerged during the first 3 years since dialysis initiation, especially within the first year (SIR = 8.52, 95% CI: 6.89–10.41). Elevated excess risks were observed for kidney (SIR = 3.18; 95% CI: 2.06–4.69), skin non-melanoma (SIR = 1.81, 95% CI: 1.46–2.22), oral cavity (SIR = 2.42, 95% CI: 1.36–4.00), and Kaposi’s sarcoma (SIR = 10.29, 95% CI: 1.25–37.16).
Conclusions
The elevated risk for DNM herein documented suggest the need to implement a targeted approach to cancer prevention and control in dialysis patients.
Journal Article
Waist-circumference-to-height-ratio had better longitudinal agreement with DEXA-measured fat mass than BMI in 7237 children
Background
The absolute agreement of surrogate measures of adiposity with dual-energy X-ray absorptiometry (DEXA)-measured body composition was examined.
Methods
Over a 15-year follow-up, 7237 (3667 females) nine-year-old children from the Avon Longitudinal Study of Parents and Children (ALSPAC) UK birth cohort were included. Total fat mass (FM) and trunk FM were serially measured with DEXA at ages 9, 11, 15, 17, and 24 years. BMI and waist circumference-to-height ratio (WHtR) were computed. Pearson’s correlations, intraclass correlations (ICC), and area under curve (AUC) analyses were conducted.
Results
Over 15 years, BMI, total FM, and trunk FM, increased but WHtR was relatively stable. WHtR provided a better longitudinal absolute agreement [males ICC 0.84 (95% CI 0.84–0.85); females 0.81 (0.80–0.82)] than BMI [(males (0.65 (0.64–0.66); females 0.72 (0.71–0.73)] with total FM as well as trunk FM from ages 9–24 years. WHtR cut-point for predicting excess total FM (75th–95th percentile) was 0.50–0.53 in males [AUC 0.86–0.94, sensitivity 0.51–0.79 and specificity 0.93–0.95]. WHtR cut-point for predicting excess total FM (75th–95th percentile) was 0.52–0.54 in females [AUC 0.83–0.95, sensitivity 0.38–0.68 and specificity 0.92–0.95]. Results were similar with trunk FM.
Conclusion
WHtR is an inexpensive alternative to BMI for predicting FM in pediatrics.
Impact
Waist circumference-to-height ratio (WHtR) is a better adiposity surrogate measure than body mass index (BMI) in predicting fat mass and discriminating lean mass from childhood through young adulthood.
BMI has been used as an inexpensive surrogate measure of adiposity in children for several decades. However, emerging findings suggest that BMI fails to discriminate between fat mass adiposity and lean mass.
This is the first-ever longitudinal study in over 7000 children followed up for 15 years that identified WHtR as an inexpensive accurate measure that discriminates fat mass from lean mass that could replace BMI measure of obesity in pediatrics.
Journal Article
Structural racism is associated with adverse postnatal outcomes among Black preterm infants
Background
Structural racism contributes to racial disparities in adverse perinatal outcomes. We sought to determine if structural racism is associated with adverse outcomes among Black preterm infants postnatally.
Methods
Observational cohort study of 13,321 Black birthing people who delivered preterm (gestational age 22–36 weeks) in California in 2011–2017 using a statewide birth cohort database and the American Community Survey. Racial and income segregation was quantified by the Index of Concentration at the Extremes (ICE) scores. Multivariable generalized estimating equations regression models were fit to test the association between ICE scores and adverse postnatal outcomes: frequent acute care visits, readmissions, and pre- and post-discharge death, adjusting for infant and birthing person characteristics and social factors.
Results
Black birthing people who delivered preterm in the least privileged ICE tertiles were more likely to have infants who experienced frequent acute care visits (crude risk ratio [cRR] 1.3 95% CI 1.2–1.4), readmissions (cRR 1.1 95% CI 1.0–1.2), and post-discharge death (cRR 1.9 95% CI 1.2–3.1) in their first year compared to those in the privileged tertile. Results did not differ significantly after adjusting for infant or birthing person characteristics.
Conclusion
Structural racism contributes to adverse outcomes for Black preterm infants after hospital discharge.
Impact statement
Structural racism, measured by racial and income segregation, was associated with adverse postnatal outcomes among Black preterm infants including frequent acute care visits, rehospitalizations, and death after hospital discharge.
This study extends our understanding of the impact of structural racism on the health of Black preterm infants beyond the perinatal period and provides reinforcement to the concept of structural racism contributing to racial disparities in poor postnatal outcomes for preterm infants.
Identifying structural racism as a primary cause of racial disparities in the postnatal period is necessary to prioritize and implement appropriate structural interventions to improve outcomes.
Journal Article
Maternal serum levels of perfluoroalkyl substances in early pregnancy and offspring birth weight
BackgroundPerfluoroalkyl substances (PFASs) are widespread, bioaccumulating, and persistent and show placental transfer. Emerging research indicates associations between prenatal exposure and low birth weight. The aim of this study was to assess the associations between first trimester exposure to PFASs and birth weight (BW) in the Swedish Environmental, Longitudinal, Mother and child, Asthma and allergy (SELMA) study and examine whether associations differ between girls and boys.MethodsEight PFASs were analyzed in maternal serum (median: 10 weeks of pregnancy). Associations between prenatal PFAS exposure and birth outcomes with BW, BW for gestational age, and birth small for gestational age (SGA) were assessed in 1533 infants, adjusted for potential confounders and stratified by sex.ResultsIncreased maternal perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) were associated with lower BW, lower BW for gestational age, and SGA birth. Associations were significant only in girls, where prenatal exposure in the upper quartile was associated with a 93–142-g lower BW when compared with that of the lowest quartile exposure. The associations were not mediated by effects on gestational age.ConclusionsWe found associations between prenatal exposure for five different PFASs and birth weight, with more pronounced associations in girls than in boys.
Journal Article
Associations between media parenting practices and early adolescent screen use
Background
To assess the prevalence of various media parenting practices and identify their associations with early adolescent screen time and problematic social media, video game, and mobile phone use.
Methods
Cross-sectional data from Year 3 of the Adolescent Brain Cognitive Development (ABCD) Study (2019–2022) that included 10,048 adolescents (12–13 years, 48.3% female, 45.6% racial/ethnic minorities) in the US were analyzed using multiple linear regression analyses adjusting for potential confounders.
Results
Parent screen use, family mealtime screen use, and bedroom screen use were associated with greater adolescent screen time and problematic social media, video game, and mobile phone use. Parental use of screens to control behavior (e.g., as a reward or punishment) was associated with higher screen time and greater problematic video game use. Parental monitoring of screens was associated with lower screen time and less problematic social media and mobile phone use. Parental limit setting of screens was associated with lower screen time and less problematic social media, video game, and mobile phone use.
Discussion
Parent screen use, mealtime screen use, and bedroom screen use were associated with higher adolescent problematic screen use and could be limited in a family media use plan. Parental monitoring and limiting of screen time are associated with less problematic screen use.
Impact statement
Although the American Academy of Pediatrics provides guidance for screen use for children 5–18 years, there is a paucity of evidence-based guidance for media parenting practices, specifically for early adolescents.
In a diverse sample of 10,048 early adolescents across the US, we found cross-sectional associations between parent, mealtime, and bedroom screen use and higher adolescent problematic screen use.
Parental monitoring and limiting of adolescent screen time were cross-sectionally associated with less problematic screen use in our analytic sample and may be incorporated into a family media use plan.
Journal Article
Postnatal growth of small for gestational age late preterm infants: determinants of catch-up growth
Background
Failure to recover growth is a risk reported in late preterm population. This study aimed to evaluate the auxological outcome of late preterm infants and identify factors associated with failure to recover growth.
Methods
We enrolled late preterm infants with birth weight ≤10th percentile, followed up at High-Risk Infant Follow-up Service. We collected data at birth and at follow-up visits. A logistic regression analysis was performed to assess variables independently associated with growth failure.
Results
The population consisted of 175 preterms. The percentage of children showing no weight recovery was 34% at 36 months. At logistic regression analysis, infants who had not regained weight at 12 months had a higher risk of not regaining weight even at 36 months. The same risk factor was highlighted for length catch-up growth. Moreover, infants fed any human milk at discharge were protected from not achieving both weight and length catch-up growth at 36 months.
Conclusion
These results indicate that children born late preterm and small for gestational age could fail to recover weight and stature growth in the first 36 months. The protective effect of human milk on failure to thrive highlights the importance of promoting breastfeeding in this population.
Impact
A significant number of SGA late preterms show a failure to recover weight and statural growth.
Having experienced intrauterine growth restriction is associated with a greater chance of achieving statural catch-up growth.
Being born singleton represents a risk factor for slower weight and height growth velocity.
Breastmilk has a protective effect on failure to recover adequate weight and length in preterm SGA infants. This finding highlights the importance of promoting breastfeeding in this population.
Journal Article
Incidence of anxiety and depression in children and young people with life-limiting conditions
Background
The aim of this study was to investigate the incidence of anxiety and depression in children and young people with life-limiting conditions.
Methods
A comparative cohort study was conducted, using primary and secondary care data from the Clinical Practice Research Datalink (CPRD) in England. Anxiety and depression codes were identified using diagnostic, symptom and prescription codes. Incidence rates of anxiety and depression were compared across condition groups using Poisson regression, adjusting for sex, age, ethnicity, and deprivation status.
Results
A total of 25,313 children and young people were included in the study: 5527 with life-limiting conditions, 6729 with chronic conditions, and 13,057 with no long-term conditions. The incidence of anxiety (IRR
adj
: 1.39, 95% CI: 1.09–1.77) and depression (IRR
adj
: 1.41, 95% CI: 1.08–1.83) was significantly higher in children and young people with life-limiting conditions, compared to children and young people with no long-term conditions.
Conclusions
The higher incidence of anxiety and depression observed among children and young people with life-limiting conditions highlights the need for psychological support in this population, including further efforts to prevent, identify, and treat anxiety and depression.
Impact
The analysis of primary and secondary healthcare data from England revealed that the incidence of anxiety and depression was higher among children and young people with life-limiting conditions, compared to those with no long-term conditions.
This is the first study to investigate the incidence of anxiety and depression in children and young people with a wide range of life-limiting conditions.
The higher incidence of anxiety and depression observed in children and young people with life-limiting conditions highlights the need for psychological support aiming to prevent, identify, and treat anxiety and depression in this population group.
Journal Article
Social epidemiology of early adolescent problematic screen use in the United States
ObjectiveTo determine sociodemographic correlates of problematic screen use (social media, video games, mobile phones) among a racially/ethnically and socioeconomically diverse population-based sample of 10–14-year-old early adolescents.Study designWe analyzed cross-sectional data from the Adolescent Brain Cognitive Development Study (Year 2, 2018–2020; N = 8753). Multiple linear regression analyses were used to estimate associations between sociodemographic factors (age, sex, race/ethnicity, primary language, household income, parental education) and adolescent-reported problematic video game (Video Game Addiction Questionnaire), social media (Social Media Addiction Questionnaire), and mobile phone use (Mobile Phone Involvement Questionnaire).ResultsBoys reported higher problematic video game use while girls reported higher problematic social media and mobile phone use. Native American, black, and Latinx adolescents reported higher scores across all problematic screen measures compared to non-Latinx white adolescents. Having unmarried/unpartnered parents was associated with higher problematic social media use. Although higher household income was generally protective against problematic video game use, these associations were weaker for black than white adolescents (p for interaction <0.05).ConclusionsGiven the sociodemographic differences in problematic screen use, digital literacy education strategies can focus on at-risk populations, encourage targeted counseling by pediatricians, and adapt family media use plans for diverse backgrounds.ImpactWhile sociodemographic differences in screen time are documented, we examined sociodemographic differences in problematic screen use in a large, diverse sample of early adolescents in the US.Boys reported higher problematic video game use while girls reported higher problematic social media and mobile phone use.Native American, black, and Latinx adolescents reported higher scores across all problematic screen measures compared to non-Latinx white adolescents.Although higher household income was generally protective against problematic video game use, these associations were weaker for black than white adolescents.Beyond time spent on screens, pediatricians, parents, and educators should be aware of sociodemographic differences in problematic screen use.
Journal Article