AIMS: Specific patterns in incidence may reveal environmental explanations for type 1 diabetes incidence. We aimed to study type 1 diabetes incidence in European childhood populations to assess whether an increase could be attributed to either period or cohort effects. METHODS: Nineteen EURODIAB centres provided single year incidence data for ages 0-14 in the 25-year period 1989-2013. Case counts and person years were classified by age, period and cohort (APC) in 1-year classes. APC Poisson regression models of rates were fitted using restricted cubic splines for age, period and cohort per centre and sex. Joint models were fitted for all centres and sexes, to find a parsimonious model. RESULTS: A total of 57,487 cases were included. In ten and seven of the 19 centres the APC models showed evidence of nonlinear cohort effects or period effects, respectively, in one or both sexes and indications of sex-specific age effects. Models showed a positive linear increase ranging from approximately 0.6 to 6.6%/year. Centres with low incidence rates showed the highest overall increase. A final joint model showed incidence peak at age 11.6 and 12.6 for girls and boys, respectively, and the rate-ratio was according to sex below 1 in ages 5-12. CONCLUSION: There was reasonable evidence for similar age-specific type 1 diabetes incidence rates across the EURODIAB population and peaks at a younger age for girls than boys. Cohort effects showed nonlinearity but varied between centres and the model did not contribute convincingly to identification of environmental causes of the increase.

Centre for Public Health Queen's University Belfast Belfast UK

Clinical Epidemiology Research Steno Diabetes Center Copenhagen Herlev Denmark

Department of Children's Diabetology Medical University of Silesia Katowice Poland

Department of Clinical Medicine Copenhagen University Copenhagen Denmark

Department of Endocrinology and Genetics University Children's Hospital Skopje North Macedonia

Department of Health Government of Catalonia Barcelona Spain

Department of Paediatric Diabetes and Endocrinology University of Luxembourg Esch sur Alzette Luxembourg

Department of Pediatric and Adolescent Medicine Medical University of Vienna Vienna Austria

Department of Pediatrics 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czechia

Diabetes and Metabolic Diseases Department of Endocrinology University Children's Hospital Ljubljana Slovenia

Diabetes and Metabolism Bristol Medical School University of Bristol Bristol UK

Diabetes Research Center Brussels Free University Vrije Universiteit Brussel Brussels Belgium

Diabetes Technology Research Steno Diabetes Center Copenhagen Borgmester Ib Juuls Vej 83 2730 Herlev Denmark

Division of Adolescent and Paediatric Medicine Institute of Clinical Medicine Oslo University Hospital University of Oslo Oslo Norway

Division of Paediatric Endocrinology and Diabetology and Children's Research Center University Children's Hospital University of Zurich Zurich Switzerland

German Diabetes Center Institute of Biometrics and Epidemiology Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany

Institute of Endocrinology Lithuanian University of Health Sciences Kaunas Lithuania

Institute of Microbiology and Virology Lithuanian University of Health Sciences Kaunas Lithuania

Leeds Institute for Data Analytics School of Medicine University of Leeds Leeds UK

National Institute of Diabetes Nutrition and Metabolic Diseases NC Paulescu Bucharest Romania

University Children´S Hospital Tübingen Germany

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