I believe that the incidence of diabetes should be highest in communities in which (1) the average age is greatest, (2) women predominate, (3) obesity is most frequent, (4) the proportion of Jews is greatest, (5) medical supervision is closest and (6) deaths are most accurately reported. Therefore I am puzzled to explain why the mortality from diabetes should be nearly twice as high in the United States as in Canada, when the two countries are separated only by an arbitrary line. Why should the incidence of diabetes double in the United States in the ten years 1880 to 1890 and then take thirty years to do so again—between 1900 and 1930? Why should it double in Italy and Switzerland between 1920 and 1934? Why should the death rate from diabetes in Rhode Island in 1937 be four times that in Arizona or, to make the question more general, why
JOSLIN EP. THE UNIVERSALITY OF DIABETES: A SURVEY OF DIABETIC MORBIDITY IN ARIZONA THE FRANK BILLINGS LECTURE. JAMA. 1940;115(24):2033–2038. doi:10.1001/jama.1940.02810500001001
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