Urban and rural differences in new onset type 2 diabetes: Comparisons across national and regional samples in the diabetes LEAD network

Tara P McAlexander; Gargya Malla; Jalal Uddin; David C Lee; Brian S Schwartz; Deborah B Rolka; Karen R Siegel; Rania Kanchi; Jonathan Pollak; Linda Andes; April P Carson; Lorna E Thorpe; Leslie A McClure

doi:10.1016/j.ssmph.2022.101161

Urban and rural differences in new onset type 2 diabetes: Comparisons across national and regional samples in the diabetes LEAD network

SSM Popul Health. 2022 Jul 14:19:101161. doi: 10.1016/j.ssmph.2022.101161. eCollection 2022 Sep.

Authors

Tara P McAlexander¹, Gargya Malla², Jalal Uddin², David C Lee^{3

4}, Brian S Schwartz^{5

6

7}, Deborah B Rolka⁸, Karen R Siegel⁸, Rania Kanchi³, Jonathan Pollak⁵, Linda Andes⁸, April P Carson⁹, Lorna E Thorpe³, Leslie A McClure¹

Affiliations

¹ Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
² Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
⁴ Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA.
⁵ Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁹ Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39213, USA.

Abstract

Introduction: Geographic disparities in diabetes burden exist throughout the United States (US), with many risk factors for diabetes clustering at a community or neighborhood level. We hypothesized that the likelihood of new onset type 2 diabetes (T2D) would differ by community type in three large study samples covering the US.

Research design and methods: We evaluated the likelihood of new onset T2D by a census tract-level measure of community type, a modification of RUCA designations (higher density urban, lower density urban, suburban/small town, and rural) in three longitudinal US study samples (REGARDS [REasons for Geographic and Racial Differences in Stroke] cohort, VADR [Veterans Affairs Diabetes Risk] cohort, Geisinger electronic health records) representing the CDC Diabetes LEAD (Location, Environmental Attributes, and Disparities) Network.

Results: In the REGARDS sample, residing in higher density urban community types was associated with the lowest odds of new onset T2D (OR [95% CI]: 0.80 [0.66, 0.97]) compared to rural community types; in the Geisinger sample, residing in higher density urban community types was associated with the highest odds of new onset T2D (OR [95% CI]: 1.20 [1.06, 1.35]) compared to rural community types. In the VADR sample, suburban/small town community types had the lowest hazard ratios of new onset T2D (HR [95% CI]: 0.99 [0.98, 1.00]). However, in a regional stratified analysis of the VADR sample, the likelihood of new onset T2D was consistent with findings in the REGARDS and Geisinger samples, with highest likelihood of T2D in the rural South and in the higher density urban communities of the Northeast and West regions; likelihood of T2D did not differ by community type in the Midwest.

Conclusions: The likelihood of new onset T2D by community type varied by region of the US. In the South, the likelihood of new onset T2D was higher among those residing in rural communities.

Keywords: Community type; Diabetes; Geographic disparities; Rural; Urban.

Grants and funding

U01 DP006299/DP/NCCDPHP CDC HHS/United States