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Urban and rural differences in new onset type 2 diabetes: Comparisons across national and regional samples in the diabetes LEAD network
Journal article   Open access   Peer reviewed

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, …
SSM - population health, v 19, 101161
Sep 2022
DOI: https://doi.org/10.1016/j.ssmph.2022.101161
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.ssmph.2022.101161View
Published, Version of Record (VoR)CC BY-NC-ND V4.0,  Open

Abstract

Community type Diabetes Geographic disparities Rural Urban
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. 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. 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. 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. •Growing evidence suggests that community contextual factors play a critical role in type 2 diabetes (T2D) risk.•Substantial rural and urban disparities in diabetes-related risk factors and outcomes exist in the US.•In three regional and national study samples in the US, we observed differences in T2D risk by community type and region.•These findings suggest that regional and community type-specific risk factors could impact T2D risk.

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21 citations in Web of Science
20 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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