Higher incidence of childhood-onset type 1 diabetes mellitus in remote areas: a UK regional small-area analysis

Aims/hypothesis: We investigated the association between the incidence of type 1 diabetes mellitus and remoteness (a proxy measure for exposure to infections) using recently developed techniques for statistical analysis of small-area data.

Subjects, materials and methods: New cases in children aged 0 to 14 years in Northern Ireland were prospectively registered from 1989 to 2003. Ecological analysis was conducted using small geographical units (582 electoral wards) and area characteristics including remoteness, deprivation and child population density. Analysis was conducted using Poisson regression models and Bayesian
hierarchical models to allow for spatially correlated risks that were potentially caused by unmeasured explanatory variables.

Results: In Northern Ireland between 1989 and 2003, there were 1,433 new cases of type 1 diabetes, giving a directly standardised incidence rate of 24.7 per 100,000 personyears. Areas in the most remote fifth of all areas had a significantly (p=0.0006) higher incidence of type 1 diabetes mellitus (incidence rate ratio=1.27 [95% CI 1.07, 1.50]) than those in the most accessible fifth of all areas. There was also a higher incidence rate in areas that were less deprived (p<0.0001) and less densely populated (p=0.002). After adjustment for deprivation and additional adjustment for child population density the association between diabetes and remoteness remained significant (p=0.01 and p=0.03, respectively).

Conclusions/interpretation: In Northern Ireland, there is evidence that remote areas experience higher rates of type 1 diabetes mellitus. This could reflect a reduced or delayed exposure to infections, particularly early in life, in these areas.

Places making: participatory construction of scientifi c culture cities

In the framework of the European project Platform of Local Authorities and Communicators Engaged in Science (PLACES), we analyse the articulations between scientifi c communication, public perception of science, processes of citizen participation and apropiation of space, based on a case study of the inhabitants of Teruel city, Autonomous Community of Aragon, Spain. On the interrelationships between these issues, there are a number of contradictions, such as the difference between a high interest for information about science and technology and a low level of recognition and interaction with local institutions involved in those activities, the complex conceptualization of scientifi c space in relation to the “public-private” pair, or an articulation of a claiming civic rethoric and an insuffi cient co-responsibility. We conclude that, in a local context, the dimension of territoriality and, in particular, the identifi cation with the town, is a central mediation for activating citizen participation as part of processes of appropriation of space for setting up cities of scientifi c culture.