Increase in the incidence of type 1 diabetes in Israeli children following the Second Lebanon War

Amnon Zung, Orit Blumenfeld, Naim Shehadeh, Orna Dally Gottfried, Yardena Tenenbaum Rakover, Eli Hershkovitz, David Gillis, David Zangen, Orit Pinhas-Hamiel, Aaron Hanukoglu, Marianna Rachmiel, Shlomit Shalitin, Zvy Bistritzer, Pnina Vardi, Ilana Koren, Alina German, David Strich, Nachum Terespolsky, Zohar Landau, Ram WeissOsnat Admoni, Mary Barhum, Anat Jaffe, Zvi Zadik, Ella Burundukov, Chana Graf-Barel, Moshe Karp, Zohar Landau, Kineret Mazor-Aronovitch, Rachel Frumkin, Orna Dally Gottfries, Dalit Modan Moses, Yael Levi-Shraga, Gherta Brill, Michal Ben-Ami, Heddy Landau, Moshe Philip, Liora Lazar, Liat De Vries, Revital Nimri, Yael Lebenthal, Ariel Tenenbaum, Rachel Frumkin, Meyerovitch Josef, Harry J. Hirsch, Floris Levy, Neta Leventhal, Alon Haim, Naomi Weintrob, Eyal Ory, Lea Even

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background: Type 1 diabetes is an autoimmune disease occurring in genetically susceptible individuals. The precipitating cause is unclear. Recently, the Second Lebanon War exposed a large civilian population in northern Israel to significant psychological stress in the form of repeated barrages of missile attacks. Hypothesis: We hypothesized that trends in regional incidence of type 1 diabetes before and after the war would reflect an association with stress. Methods: All type 1 diabetes patients aged 0-17 yr who were reported to the Israel Juvenile Diabetes Register (n = 1822) in the four pre-war (2002-2005) and two post-war years (2006-2007) were included in the study. The patients were stratified by gender, age, ethnicity, family history of type 1 diabetes, season at diagnosis, and region of residency, namely, those who lived in the northern regions that were attacked and those in other regions. Results: The post-war incidence of type 1 diabetes was increased in the northern regions (rate ratio, RR = 1.27; p = 0.037), with no change in the other regions. This change was more prominent in males (RR = 1.55; p = 0.005) but similar in summer and winter, in different ages, and in different ethnic groups. There was no change in the proportion of new patients with a family history of the disease. Conclusions: For the first time in a large population, we found a positive association between the trauma of war and an increase in the incidence of type 1 diabetes in children and adolescents. The increase in incidence was not associated with genetic susceptibility to the disease.

Original languageEnglish
Pages (from-to)326-333
Number of pages8
JournalPediatric Diabetes
Issue number4
StatePublished - Jun 2012
Externally publishedYes


  • Children
  • Incidence
  • Psychological stress
  • Type 1 diabetes
  • War


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