title: Vulnerability to diabetes in Chinese: an age-period-cohort analysis.
abstract: OBJECTIVE
  Hong Kong, in common with other Asian settings, has high rates of diabetes mellitus (DM) despite a relatively nonobese population. Given the rapid economic development in the region, most Asians grew up in limited living conditions. We examined the longitudinal mortality trends of DM. We assessed whether the first generation (birth cohorts in the 1930s) with late adolescence in a more economically developed environment had a lower risk of DM.
  
  
  METHODS
  We used DM deaths and population figures in Hong Kong, 1976 to 2010. We fitted age-period-cohort models to decompose mortality rates into effects for age at mortality, calendar period of mortality, and birth cohort.
  
  
  RESULTS
  The risk of death from DM fell for the first generation (births in the early 1930s) with late adolescence in Hong Kong, but possibly the risk rose again for the first generation (birth 1960s) affected by the obesity epidemic.
  
  
  CONCLUSIONS
  Adiposity might contribute to diabetes in Hong Kong, and similar Asian settings, however current vulnerability of many older Asians to DM in plentiful environments may be the result of limited living conditions until adulthood. Furthermore, our findings are more consistent with limited adolescent conditions than fetal undernutrition playing a role in vulnerability to DM.
authors.affiliation: Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China.
authors.forename: Irene O L
authors.initials: IO
authors.lastname: Wong
authors.affiliation: Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cowling
authors.affiliation: Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; CUNY School of Public Health and Hunter College, New York, NY. Electronic address: cms1@hkucc.hku.hk.
authors.forename: Catherine Mary
authors.initials: CM
authors.lastname: Schooling
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D044466:Asian People; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D057217:Economic Development / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D012111:Residence Characteristics; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors
keywords: Chinese; Diabetes mellitus; Economic development; Mortality; Secular trends