title: Increase in the incidence of type 1 diabetes in Israeli children following the Second Lebanon War.
abstract: BACKGROUND
  Type 1 diabetes is an autoimmune disease occurring in genetically susceptible individuals. The precipitating cause is unclear. Recently, the Second Lebanon War exposed a large civilian population in northern Israel to significant psychological stress in the form of repeated barrages of missile attacks.
  
  
  OBJECTIVE
  We hypothesized that trends in regional incidence of type 1 diabetes before and after the war would reflect an association with stress.
  
  
  METHODS
  All type 1 diabetes patients aged 0-17 yr who were reported to the Israel Juvenile Diabetes Register (n = 1822) in the four pre-war (2002-2005) and two post-war years (2006-2007) were included in the study. The patients were stratified by gender, age, ethnicity, family history of type 1 diabetes, season at diagnosis, and region of residency, namely, those who lived in the northern regions that were attacked and those in other regions.
  
  
  RESULTS
  The post-war incidence of type 1 diabetes was increased in the northern regions (rate ratio, RR = 1.27; p = 0.037), with no change in the other regions. This change was more prominent in males (RR = 1.55; p = 0.005) but similar in summer and winter, in different ages, and in different ethnic groups. There was no change in the proportion of new patients with a family history of the disease.
  
  
  CONCLUSIONS
  For the first time in a large population, we found a positive association between the trauma of war and an increase in the incidence of type 1 diabetes in children and adolescents. The increase in incidence was not associated with genetic susceptibility to the disease.
authors.affiliation: Pediatric Endocrinology Unit, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot 76100, Israel. amzung2@bezeqint.net
authors.forename: Amnon
authors.initials: A
authors.lastname: Zung
authors.forename: Orit
authors.initials: O
authors.lastname: Blumenfeld
authors.forename: Naim
authors.initials: N
authors.lastname: Shehadeh
authors.forename: Orna
authors.initials: O
authors.lastname: Dally Gottfried
authors.forename: Yardena
authors.initials: Y
authors.lastname: Tenenbaum Rakover
authors.forename: Eli
authors.initials: E
authors.lastname: Hershkovitz
authors.forename: David
authors.initials: D
authors.lastname: Gillis
authors.forename: David
authors.initials: D
authors.lastname: Zangen
authors.forename: Orit
authors.initials: O
authors.lastname: Pinhas-Hamiel
authors.forename: Aaron
authors.initials: A
authors.lastname: Hanukoglu
authors.forename: Marianna
authors.initials: M
authors.lastname: Rachmiel
authors.forename: Shlomit
authors.initials: S
authors.lastname: Shalitin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D012621:Seasons; D013313:Stress Disorders, Post-Traumatic; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology; D014857:Warfare