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Keywords:

  • children;
  • incidence;
  • psychological stress;
  • type 1 diabetes;
  • war

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.