title: Equal access to health care may diminish the differences in outcome between native and immigrant patients with type 1 diabetes.
abstract: OBJECTIVE
  Previous studies have found that ethnicity influences glycemic control. We hypothesized that differences between Nordic and non-Nordic patients are less pronounced for children with type 1 diabetes in high incidence countries in Northern Europe.
  
  
  METHODS
  We investigated patients aged 0-15 yr in national pediatric registers in Denmark (D), Iceland (I), Norway (N), and Sweden (S) (2006-2009). Ethnic origin was defined by maternal country of birth as being Nordic or non-Nordic (other countries).
  
  
  RESULTS
  The cohort (n = 11,908, 53.0% boys, onset age 7.7 (3.9) yr, diabetes duration 6.1 (3.6) yr, [mean, (SD)]) comprised 921 (7.7%) non-Nordic patients. The frequencies of non-Nordic patients according to country of residence were: 5.7% (D), 2.7% (I), 5.5% (N), and 9.4% (S). Sex distribution and BMI z-score did not differ between Nordic and non-Nordic patients, but non-Nordic patients were 0.5 yr younger at onset than Nordic patients (p < 0.0006). Non-Nordic patients had a lower number of daily insulin bolus injections and higher daily insulin doses compared to their Nordic peers. Patients of non-Nordic origin had slightly higher HbA1c levels (0.6-2.9 mmol/mol, p < 0.001) and, with the exception of Norway, were less frequently treated with CSII (p = 0.002) after adjusting for confounders.
  
  
  CONCLUSIONS
  The reported differences in glycemic regulation between Nordic and non-Nordic type 1 diabetes children and adolescents in four Nordic countries are diminutive, but persist after accounting for treatment intensity.
authors.affiliation: Department of Pediatrics, Herlev Hospital, Herlev, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Siri
authors.initials: S
authors.lastname: Fredheim
authors.forename: Ahmed
authors.initials: A
authors.lastname: Delli
authors.forename: Heba
authors.initials: H
authors.lastname: Rida
authors.forename: Ann-Kristin
authors.initials: AK
authors.lastname: Drivvoll
authors.forename: Torild
authors.initials: T
authors.lastname: Skrivarhaug
authors.forename: Ragnar
authors.initials: R
authors.lastname: Bjarnason
authors.forename: Arni
authors.initials: A
authors.lastname: Thorsson
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindblad
authors.forename: Jannet
authors.initials: J
authors.lastname: Svensson
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D054242:Emigrants and Immigrants; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D009035:Mothers; D012042:Registries; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Denmark; Iceland; Nordic; Norway; Sweden; ethnicity; population register; treatment; type 1 diabetes