Diverging regional inequalities in childhood diabetes, 1990-2023: a GBD 2023-based analysis

Childhood diabetes continues to rise, with wide variation across regions and income levels. We performed a cross-sectional analysis using Global Burden of Disease 2023 estimates for children aged 0-14 years across super regions, regions, and countries from 1990 to 2023. The primary objective was to characterize regional inequalities in incidence, mortality, and disability-adjusted life years, and to assess whether these inequalities are likely to persist in the future. Age-standardized incidence, mortality, and disability-adjusted life year rates were estimated per 100,000 population with 95% uncertainty intervals. Regional and national comparisons, temporal trend analyses, and socioeconomic gradient analyses were employed as core analyses. Risk factor attribution, the Quality of Care Index, Shapley additive explanations-based predictor contribution analysis, and Bayesian age-period-cohort forecasting were used as supportive analyses to interpret risk-attributable mortality patterns, care-related performance gaps, demographic and temporal contributors, and future incidence trajectories. From 1990 to 2023, childhood diabetes incidence increased in most regions, while mortality and disability declined overall. High-income North America had the highest incidence in 2023, whereas Western Sub-Saharan Africa had the greatest mortality and disability burden. Finland had the highest incidence, Qatar, Chile, and South Korea showed rapid incidence increases, and Nigeria had the highest mortality burden. Projections suggested stabilizing incidence in the United States but continued increases in China, India, Poland, Finland, and Qatar. Childhood diabetes shows persistent regional inequalities, highlighting the need for earlier diagnosis, reliable insulin access, and stronger pediatric diabetes systems in resource-limited settings.