The Distribution of Type 1 Diabetes Onset in the United States by Demographic Factors

The Distribution of Type 1 Diabetes Onset in the United States by Demographic Factors by Margaret Beckstrand MPH, University of California at Los Angeles, 1997 BS, California Polytechnic at San Luis Obispo, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2015 Abstract Type 1 diabetes (T1D) is a chronic and lifelong condition, often diagnosed in childhood. Patients with T1D are at elevated risks of associated health complications, comorbidities, and mortality. Occurrence, clinical presentation, and complications related to T1D differ by age of onset, ethnicity, and gender. The last reported population-based estimatesType 1 diabetes (T1D) is a chronic and lifelong condition, often diagnosed in childhood. Patients with T1D are at elevated risks of associated health complications, comorbidities, and mortality. Occurrence, clinical presentation, and complications related to T1D differ by age of onset, ethnicity, and gender. The last reported population-based estimates regarding the burden of T1D in children using the National Health and Nutrition Examination Survey (NHANES) were published in 2008, and these estimates were not well stratified by age of onset, ethnicity, and gender. The purpose of this study was to examine these demographics within the conceptual framework of the hygiene hypothesis using data from NHANES from 1999 to 2012. A cross-sectional study design was used to determine the average age of onset of T1D with respect to ethnicity and gender and to assess if age of onset is associated with ethnicity and gender. The average age of onset was 10.5 years for males and 11.8 years for females. The average age of onset was 13.0 years for Hispanics, 12.7 years for Non-Hispanic Blacks, and 10.6 years for NonHispanic Whites. Regression analysis indicated that there was no significant association between age of onset and gender (β = 1.1, p = 0.386) and between age of onset and ethnicity (β = 2.1, p = 0.070 for Hispanic White; β = 1.9, p = 0.101 for Non-Hispanic Black) having considered the Non-Hispanic White as the reference population. The result of this study may contribute to positive social change by providing better insight on demographic determinants of the risk of T1D, which is crucially important in the planning and implementation of prevention measures in highly susceptible populations. The Distribution of Type 1 Diabetes Onset in the United States by Demographic Factors by Margaret Beckstrand MPH, University of California at Los Angeles BS, California Polytechnic at San Luis Obispo Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2015 Dedication This dissertation is lovingly dedicated to my children, whose contagious smiles, generous hearts, and bright futures provided me with the courage to pursue diabetes research in the face of all its uncertainties. I would also like to dedicate this massive undertaking to my husband, whose support and infinite patience have enabled me to progress so far. Plus, the daily laughter he creates has been crucial for me on this academy journey; it has helped though the tough/multitasking-times and “see the forest through the trees. ” Finally, I would also like to dedicate this research to my parents. They are the inspiration for this work and it is mainly because of their love and wisdom that I am who I am today. I feel overwhelmingly blessed to have such thoughtful and exceptional parents. I am deeply indebted to these five key players in my life who, along with others, motivate and encourage me each and every day; I love you all so very, very much. Acknowledgments I would like to express my deepest appreciation to my committee chair, Dr. Joseph Robare, whose sincere guidance and involvement was indispensable to me during this process. I would also like to thank my committee members, Dr. Shana Morrell and Dr. Gudeta Fufaa, for their expert insight and hours of review. In particular, I am profoundly thankful for Dr. Morrell’s assistance with editing and analyzing the content of this dissertation. Dr. Morrell’s perceptive questions, extensive knowledge, considered and thoughtful approach to this important work was truly invaluable. This dissertation could not have been possible without the CDC’s work on our United States National Health and Nutrition Examination Survey (NHANES) program. From the questionnaire designers and interviewers, to the database managers and SAS programmers, the CDC staff’s diligent work provided the excellent documentation and important data integral to my dissertation. Also, I appreciate the over seventy thousand people who participated in NHANES across our nation; this dissertation would not have been feasible without them. Lastly, I would like to thank all of my family and friends for their words of encouragement. Thank you.thank you.thank you.