title: A six-fold gradient in the incidence of type 1 diabetes at the eastern border of Finland.
abstract: OBJECTIVE
  Type 1 diabetes results from gene-environment interactions in subjects with genetic susceptibility to the disease. We assessed the contribution of environmental and genetic factors to type 1 diabetes by comparing the incidence in two neighboring populations living in conspicuously different socioeconomic circumstances.
  
  
  METHODS
  We compared the incidence over a 10-year period (1990-99) in children younger than 15 years of age living in the Karelian Republic of Russia and in Finland. The frequency of susceptible and protective human leukocyte antigen (HLA)-DQ alleles was analyzed in 400 non-diabetic schoolchildren from Russian Karelia and 1000 Finnish subjects.
  
  
  RESULTS
  The average annual age-adjusted incidence of type 1 diabetes was lower in Russian Karelia than in Finland: 7.4 per 100000 (95% confidence interval 3.5-11.3) versus 41.4 per 100000 (37.3-45.5), while there were no differences in the frequency of the HLA DQ genotypes predisposing to type 1 diabetes in the background populations. The incidence rate did not differ significantly between different ethnic groups in Russian Karelia (Finns/Karelians, Russians, others).
  
  
  CONCLUSIONS
  There is a close to six-fold gradient in the incidence of type 1 diabetes between Russian Karelia and Finland, although the predisposing HLA DQ genotypes are equally frequent in the two populations. This suggests that environmental factors contribute to this steep difference in the incidence rate between these adjacent regions.
authors.affiliation: Juvenile Diabetes Research Foundation, Center for Prevention of Type 1 Diabetes, Finland.
authors.forename: Anita
authors.initials: A
authors.lastname: Kondrashova
authors.forename: Antti
authors.initials: A
authors.lastname: Reunanen
authors.forename: Anatolij
authors.initials: A
authors.lastname: Romanov
authors.forename: Aino
authors.initials: A
authors.lastname: Karvonen
authors.forename: Hanna
authors.initials: H
authors.lastname: Viskari
authors.forename: Timo
authors.initials: T
authors.lastname: Vesikari
authors.forename: Jorma
authors.initials: J
authors.lastname: Ilonen
authors.forename: Mikael
authors.initials: M
authors.lastname: Knip
authors.forename: Heikki
authors.initials: H
authors.lastname: Hyöty
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000483:Alleles; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D005260:Female; D005387:Finland / Q000453:epidemiology; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D005838:Genotype; D006683:HLA-DQ Antigens / Q000235:genetics; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D017678:Sex Distribution
chemical_list: D006683:HLA-DQ Antigens