Abstract
The association between atopic and autoimmune disease, particularly asthma and type 1 diabetes, has been debated. Further understanding of the underlying factors associated with the comorbidity in children is warranted. To assess the bidirectional association between asthma and type 1 diabetes and examine the possibility of a shared risk for the diseases by studying their pattern of familial coaggregation. A birth cohort study of children born from January 1, 2001, and followed up until December 31, 2015, was performed. Population data were obtained from multiple national Swedish registers. A total of 1 347 901 singleton children, live-born in Sweden between January 1, 2001, and December 31, 2013, were identified, and children with incomplete data were excluded. The remaining 1 284 748 children were linked to their biological full siblings, maternal and paternal half-siblings, cousins, and half-cousins. Data analysis was conducted from April 1, 2019, to January 17, 2020. Cases of asthma and type 1 diabetes were defined using a combination of diagnoses and medication prescriptions found in the registers. In the cohort of 1 284 748 children, 660 738 children (51.4%) were boys; 121 809 children (9.5%) had asthma, 3812 children (0.3%) had type 1 diabetes, and 494 children had both asthma and type 1 diabetes, representing 0.4% of all asthma or 13% of all type 1 diabetes. Mean (SD) age at diagnosis was 3.0 (2.8) years for children with asthma, and 5.9 (3.3) years for those with type 1 diabetes. Asthma and type 1 diabetes were associated within individuals (odds ratio, 1.15; 95% CI, 1.05-1.27). Children with asthma had an increased risk of subsequent type 1 diabetes (hazard ratio, 1.16; 95% CI, 1.06-1.27); however, subsequent asthma risk did not differ substantially among children with type 1 diabetes (hazard ratio, 0.92; 95% CI, 0.75-1.12). Siblings of individuals with asthma were at an increased risk of type 1 diabetes (odds ratio, 1.27; 95% CI, 1.13-1.42) and vice versa. The results remained positive after controlling for the direct association of one disease with the other. This study appears to provide evidence for co-occurrence, importance of sequential appearance, and coaggregation of asthma and type 1 diabetes in children and their siblings. The findings may suggest shared familial factors contributing to the associations. Knowledge of the nature of the association could be of importance in future clinical practice.
Highlights
Asthma is globally the most prevalent chronic childhood disease affecting approximately 11% of children aged 6 to 7 years.[1]
Asthma and type 1 diabetes were associated within individuals
Children with asthma had an increased risk of subsequent type 1 diabetes; subsequent asthma risk did not differ substantially among children with type 1 diabetes
Summary
Asthma is globally the most prevalent chronic childhood disease affecting approximately 11% of children aged 6 to 7 years.[1]. The mechanisms that factor in to the association between asthma and type 1 diabetes are still unclear. Findings of co-occurrence of the diseases within individuals are in direct opposition to the previously proposed mutual inhibition of helper T cell TH1- and TH2-mediated immune responses.[11] Instead, more complex mechanisms involving TH17 cells and regulatory T cells have been implicated.[14] In favor of the positive association between asthma and type 1 diabetes is their similar increases in incidences over the past decades.[15] This similarity could suggest a common cause owing to changes in environmental factors, such as microbial exposure, socioeconomic status, geographic location during upbringing, and diet.[15,16,17]
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