Evaluating geographic variation in type 1 and type 2 diabetes mellitus incidence in youth in four US regions

We evaluated geographic variation in type 1 and type 2 diabetes mellitus (T1DM, T2DM) in four regions of the United States. Data on 807 incident T1DM cases diabetes and 313 T2DM cases occurring in 2002-03 in South Carolina (SC) and Colorado (CO), 5 counties in Washington (WA), and an 8 county region around Cincinnati, Ohio (OH) among youth aged 10-19 years were obtained from the SEARCH for Diabetes in Youth Study. Geographic patterns were evaluated in a Bayesian framework. Incidence rates differed between the study regions, even within race/ethnic groups. Significant small-area variation within study region was observed for T1DM and T2DM. Evidence for joint spatial correlation between T1DM and T2DM was present at the county level for SC (r(SC) = 0.31) and CO non-Hispanic Whites (r(CO)=0.40) and CO Hispanics (r(CO) = 0.72). At the tract level, no evidence for meaningful joint spatial correlation was observed (r(SC) = -0.02; r(CO) = -0.02; r(OH) = 0.03; and r(WA) = 0.09). Our study provides evidence for the presence of both regional and small area, localized variation in type 1 and type 2 incidence among youth aged 10-19 years in the United States. (C) 2010 Elsevier Ltd. All rights reserved.