ImportanceA meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published.ObjectiveTo investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024.Data SourcesData from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes.Study SelectionStudies that reported a measure of association between day care attendance and risk of type 1 diabetes were included.Data Extraction and SynthesisDetails, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks.Main Outcomes and MeasuresThe principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes.ResultsSeventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37).Conclusions and RelevanceThese results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.

中文翻译：

---

日托出勤率和 1 型糖尿病的风险


重要性 2001 年发表的一项荟萃分析表明，通过日托就诊率衡量的感染暴露程度在 1 型糖尿病的发病机制中可能很重要。此后发表了几项关于该主题的新研究。目的调查日托出勤率与 1 型糖尿病风险之间的关联，并纳入截至 2024 年 3 月 10 日的所有可用文献。数据来源使用 PubMed 和 Web of Science 的数据，并辅以检索到的文章的参考书目，并检索评估日托出勤率与 1 型糖尿病风险之间关联的研究。研究选择 包括报告日托出勤率与 1 型糖尿病风险之间相关性的研究。资料提取和综合细节，包括暴露和结局评估以及混杂因素的调整，是从纳入的研究中提取的。提取了具有最大协变量数、最低协变量数和未调整估计值以及相应的 95% CI 的多变量关联。进行了 DerSimonian 和 Laird 随机效应荟萃分析，并产生了关于相对风险的保守置信区间。主要结局和测量主要关联指标是日托出勤率与无日托出勤率以及 1 型糖尿病风险。结果荟萃分析纳入 17 篇文章，包括 22 项观察性研究，涉及 100 575 名参与者。在参与者中，3693 名患有 1 型糖尿病，96 882 名是对照。发现日托出勤率与 1 型糖尿病风险呈负相关 （综合比值比，0.68;95% CI，0.58-0.79;P < .001;针对所有可用的混杂因素进行了调整）。 当分别分析纳入的 3 项队列研究时，参加日托组患 1 型糖尿病的风险降低了 15%;然而，差异无统计学意义（比值比，0.85;95% CI，0.59-1.12;P = .37）。结论和相关性这些结果表明，日托出勤似乎与降低 1 型糖尿病的风险有关。与不参加日托的儿童相比，参加日托的儿童与微生物的接触增加可能解释了这些发现。然而，需要进一步的前瞻性队列研究来证实拟议的关联。