P4.064: Burden of Type 1 Diabetes Among Children in the United States Over Three Decades

Background: Type 1 diabetes (T1D) is one of the most common chronic conditions affecting children and adolescents in the United States (U.S.), requiring lifelong insulin therapy and posing significant health, economic, and psychosocial burdens. While the incidence of T1D has been increasing globally, comprehensive national assessments evaluating its burden and temporal trends in the pediatric population remain limited. A better understanding of these patterns is essential to guide prevention strategies, optimize care delivery, and inform public health priorities.

Methods: We utilized data from the Global Burden of Disease (GBD) 2021 study to assess the burden of T1D among individuals aged 0–14 years across all 50 U.S. states and the District of Columbia. We analyzed incidence, deaths, and disability-adjusted life years (DALYs), and evaluated temporal trends from 1990 to 2021 using Estimated Annual Percentage Changes (EAPCs). Correlations between EAPCs and the Socio-Demographic Index (SDI) were assessed to explore the influence of socioeconomic factors on disease trends. Statistical analyses were performed using R (v4.3.3), with significance set at p < 0.05.

Results: From 1990 to 2021, T1D cases increased from 11,925.7 (95% UI: 8,549.8–15,871.8) to 15,050.7 (95% UI: 11,619.0–19,555.2), a 26.2% increase. The incidence rate rose by 18.7%, from 21.3 to 25.3 per 100,000 (EAPC: 0.23, 95% CI: 0.16 to 0.30). The greatest increase occurred in Pennsylvania (EAPC: 0.30, 95% CI: 0.23 to 0.38), and the lowest in Louisiana (EAPC: 0.02, 95% CI: –0.06 to 0.10). Deaths declined from 49.8 to 33.8 (–32.3%), and the death rate decreased by 36.3%, from 0.09 to 0.06 per 100,000 (EAPC: –1.53, 95% CI: –1.87 to –1.19), with the steepest reduction in Washington DC (EAPC: –4.15, 95% CI: –3.42 to –2.68). DALYs slightly decreased from 8,298.9 to 8,114.4, and the DALY rate fell by 8.0%, from 14.8 to 13.7 per 100,000 (EAPC: –0.48, 95% CI: –0.63 to –0.32), with the largest drop in District of Columbia (EAPC: -2.77, 95% CI: -2.29 to -1.81). Higher SDI was significantly associated with greater reductions in death rates (r = 0.53, p = 0.002), but not with incidence (p = 0.104) or DALYs (p = 0.502).

Conclusion: While the incidence of pediatric T1D in the U.S. has risen over the past three decades, declines in deaths and DALYs suggest improvements in disease management and access to care. The association between higher SDI and greater reductions in mortality highlights the potential impact of socioeconomic development on outcomes. However, variation in EAPCs across states underscores ongoing disparities and the need for targeted public health efforts.