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JAMA. 1933;100(10):733-735. doi:10.1001/jama.1933.02740100027011.
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In 1901 there were 501 deaths from diabetes recorded in New York City; in 1931, nearly four times as many, namely, 1,921 deaths, even though insulin had been available for a decade.

True, during these thirty years, New York's population has materially increased; in fact, doubled from three and a half millions to seven millions. Secondly, in that metropolitan center is included an unusually large proportion of Jews, with their higher susceptibility to diabetes, who are estimated to total now nearly two millions, or almost 30 per cent of the entire city. Thirdly, there has also to be taken into consideration the fact that—with the decreasing birth rate, 24 per thousand in 1901 and only 16 in 1931, along with the more effective control of infectious diseases, especially among children, and of tuberculosis, more prevalent among younger adults—the composition or age distribution of the population has been materially altered; or,


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