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The effects of type 1 diabetes mellitus on school achievements: a Swedish study using register data
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
Lunds universitet.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

OBJECTIVE: Several characteristics of type 1 diabetes mellitus (T1DM) may affect school achievements and the level of education of individuals with early onset of the disease. Evidence from earlier research showed that a childhood onset of T1DM has a negative impact on schooling among children born in the 1970s and early 1980s. Over the last decades, the management and treatment of T1DM has improved rapidly in several aspects. Additionally, the Swedish grading system changed in the late 1990s. The aim of this study is to investigate if there is an impact of T1DM on educational achievements among children born during the 1980s and early 1990s.

DATA AND METHOD: The study is based on data from the Swedish Childhood Diabetes Register (SCDR) in which Swedish incident cases of T1DM, younger than 15 years, have been reported since 1977. The SCDR, a case-control database, has been linked to several national population registers providing a rich set of variables for the analysis. We analyze the impact of T1DM on final school grades from compulsory and upper secondary school using two approaches: linear regression for estimating the conditional effect, and matching to estimate the average effect within the diabetes group.

RESULTS: The main results from the study indicate slightly lower grades in both compulsory and upper secondary school among children born and diagnosed with T1DM after 1979. The effect was small but significant using both regression and matching.

CONCLUSION: To our knowledge, this is the first study investigating the impact of T1DM on school achievements among individuals that are born during the 1980s and afterwards and have, throughout their childhood, had access to many of the essential treatment improvements seen over the last decades. The results, in line with findings from earlier research, show a small negative impact of the disease among children completing school during 1998-2010. 

Keyword [en]
average effect, educational outcomes, register study
National Category
Social Sciences Interdisciplinary
URN: urn:nbn:se:umu:diva-94969OAI: diva2:756924
Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2014-10-23
In thesis
1. Causal inference and case-control studies with applications related to childhood diabetes
Open this publication in new window or tab >>Causal inference and case-control studies with applications related to childhood diabetes
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Kausal inferens och fall-kontroll studier med applikationer inom barndiabetes
Abstract [en]

This thesis contributes to the research area of causal inference, where estimation of the effect of a treatment on an outcome of interest is the main objective. Some aspects of the estimation of average causal effects in observational studies in general, and case-control studies in particular, are explored.

An important part of estimating causal effects in an observational study is to control for covariates. The first paper of this thesis concerns the selection of minimal covariate sets sufficient for unconfoundedness of the treatment assignment. A data-driven implementation of two covariate selection algorithms is proposed and evaluated.

A common sampling scheme in epidemiology, and when investigating rare events, is the case-control design. In the second paper we study estimators of the marginal causal odds ratio in matched and independent case-control designs. Estimators that, under a logistic regression model, utilize information about the known prevalence of being a case is examined and compared through simulations.

The third paper investigates the particular situation where case-control sampled data is reused to estimate the effect of the case-defining event on an outcome of interest. The consequence of ignoring the design when estimating the average causal effect is discussed and a design-weighted matching estimator is proposed. The performance of the estimator is evaluated with simulation experiments, when matching on the covariates directly and when matching on the propensity score.

The last paper studies the effect of type 1 diabetes mellitus (T1DM) on school achievements using data from the Swedish Childhood Diabetes Register, a population-based incidence register. We apply theoretical results from the second and third papers in the estimation of the average causal effect within the T1DM population. A matching estimator that accounts for the matched case-control design is used.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 22 p.
Statistical studies, ISSN 1100-8989 ; 48
covariate selection, design-weighted estimation, marginal effect, matching, register study, treatment effect, type 1 diabetes mellitus
National Category
Probability Theory and Statistics
Research subject
urn:nbn:se:umu:diva-94993 (URN)978-91-7601-151-5 (ISBN)
Public defence
2014-11-21, Hörsal F, Humanisthuset, Umeå universitet, Umeå, 10:15 (English)
Available from: 2014-10-24 Created: 2014-10-20 Last updated: 2014-10-23Bibliographically approved

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