title: Childhood Bereavement and Type 1 Diabetes: a Danish National Register Study.
abstract: BACKGROUND
  Death of a close family member such as a parent or a sibling can cause prolonged stress and changes in the family structure that may have extensive social and health effects on a young child. The aim of this paper is to examine the rate of type 1 diabetes following bereavement due to death of a first-degree family member in early life.
  
  
  METHODS
  We used data from the Danish Civil Registration System (CRS) to identify singleton births in Denmark born 1 January 1980 through 31 December 2005, n = 1 740 245 and their next of kin. We categorised children as exposed to bereavement if they lost a mother, father or sibling from age 5 years onwards, the remaining children were considered unexposed. Children were followed until first diagnosis of diabetes, death, emigration, or 31 December 2010. We estimated incidence rate ratios (IRRs) from birth using log-linear Poisson regression models with person-years as an offset variable. Exposed children were followed up for an average of 9.1 years [standard deviation (SD) 6.7] and unexposed children were followed up for an average of 12.3 years (SD 7.3).
  
  
  RESULTS
  In our sample 94 943 children were exposed to bereavement, and 6110 cases of type 1 diabetes were identified. Bereavement was associated with an increased rate of type 1 diabetes when exposure onset began after 11 years of age (adjusted IRR 1.28, 95% confidence interval 1.08, 1.51).
  
  
  CONCLUSIONS
  We found some evidence to indicate an increase in the rate of type 1 diabetes among children exposed to bereavement when exposure occurred after 11 years of age.
authors.affiliation: Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Jasveer
authors.initials: J
authors.lastname: Virk
authors.affiliation: Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Beate
authors.initials: B
authors.lastname: Ritz
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jiong
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Obel
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
mesh_terms: D000339:Affect; D001601:Bereavement; D002648:Child; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000523:psychology*; D005220:Fathers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers; D010287:Parent-Child Relations; D012042:Registries; D012307:Risk Factors; D035781:Siblings; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology / Q000523:psychology
keywords: bereavement; stress; type 1 diabetes