Discover How Rurality Influences Diabetes in the US

Did you know that where you live can affect your likelihood of developing diabetes? An observational, cross-sectional study analyzed the relationship between US county rurality and the incidence and prevalence of diagnosed diabetes. Using data from the Centers for Disease Control and Prevention (CDC) from 2004 to 2019, the research explored diabetes rates across different levels of rurality. Let’s dive into the details and discover how our surroundings can impact our health.

Study Objective

The primary objective was to examine the differences in the incidence and prevalence of diagnosed diabetes by county rurality in the US.

Patients and Methods

This study utilized an observational, cross-sectional approach with CDC data for county-level estimates of diabetes incidence and prevalence from 2004 to 2019. Counties were categorized into six levels of rurality, ranging from large central metro counties (most urban) to noncore counties (most rural). Weighted least squares regression was used to relate rurality with diabetes incidence rates (IRs; per 1000 adults) and prevalence (percentage) in adults aged 20 years or older, adjusting for county-level sociodemographic factors such as food environment, healthcare professionals, inactivity, and obesity.

Surprising Results

Among 3,148 counties and county equivalents, both the crude incidence rate (IR) and prevalence of diabetes were highest in the most rural counties. Age and sex-adjusted models showed that the IR of diabetes increased monotonically with increasing rurality (P<.001), while prevalence showed a weak, non-monotonic but statistically significant increase (P=.002).

However, further adjustment for sociodemographic factors, including food environment and inactivity, attenuated the differences in incidence across rurality levels and reversed the pattern for prevalence. Specifically, prevalence ratios compared to large central metro counties ranged from 0.98 (95% CI, 0.97 to 0.99) for large fringe metro to 0.94 (95% CI, 0.93 to 0.96) for noncore counties.

Regional Analysis

When stratified by region and adjusted for sociodemographic factors, increasing rurality was inversely associated with diabetes incidence only in the Midwest and West, and inversely associated with prevalence in all regions.

Conclusion

The crude incidence and prevalence of diagnosed diabetes increased with increasing county rurality. However, after accounting for sociodemographic factors, county rurality showed no association with incidence and an inverse association with prevalence. These findings suggest that interventions targeting modifiable sociodemographic factors may reduce diabetes disparities by region and rurality.

Public Health Implications

This study highlights the importance of considering sociodemographic context in diabetes prevention and management. Public health strategies that improve the food environment, increase access to healthcare professionals, and encourage physical activity can be crucial in combating diabetes, especially in rural areas.

A Call to Action for Prevention

Preventing diabetes starts with awareness of how environmental and sociodemographic factors influence health. Share this article and help spread the word about the importance of a healthy environment in preventing diabetes!