REGIONAL DISPARITIES IN THE PREVALENCE OF DIAGNOSED DIABETES IN RURAL VS. URBAN UNITED STATES, 2004–2019

Abstract

OBJECTIVES
United States (US) rural, compared to nonrural populations have less access to diabetes care. It is unknown if rurality also contributes to disparities in the prevalence of diabetes. The study objective was to evaluate the trend in US prevalence of diabetes from 2004–2019 by county-rurality and region.

METHODOLOGY
We used US Centers for Disease Control and Prevention (CDC) data on prevalence of diagnosed diabetes in adults aged ≥20 years, available for 97.6% of US counties (3147/3226) from 2004–2019. Trends in annual age-adjusted prevalent diabetes rate per 100 adults (AAPR) were assessed by weighted least squares regression. Year was fitted with a spline function, and AAPR change was tested by a model-based comparison of 2019 vs. 2004.

RESULTS
The overall AAPR increased from 6.5 (per 100) in 2004 to
8.4 in 2011 and 8.8 in 2019. The 2019 vs. 2004 percentage- increase (95% confidence interval) was present at all rurality levels: 33% (27%–40%) for noncore counties (most rural), 38% (37%–38%) for large fringe metro counties (second most urban), and 35% (35%–35%) for large central metro counties (most urban) (all, p<.001). Stratified by region, the AAPR percentage-increase was lowest in the Northeast (30% [28%–33%]; p<.001) and highest in the South (40% [39%–41%]; p<.001).

CONCLUSION
The US prevalence of diabetes increased from 2004 to 2019 across all county-rurality levels. This study revealed a wor- sening trend in the South vs. other regions, which may high- light areas for interventions to reduce diabetes incidence.