Rural-Urban Disparities in State-Level Diabetes Prevalence Among US Adults, 2021

We assessed state-level disparities in diabetes prevalence among adults in rural and urban areas in the United States.

We estimated state-specific diabetes prevalence in rural and urban areas in 41 states with applicable data from the 2021 Behavioral Risk Factor Surveillance System. Rural areas were defined based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme. We estimated diabetes odds ratios (ORs) in rural versus urban areas in each state by using logistic regressions adjusted for sociodemographic characteristics and obesity status. Analyses were conducted in 2023.

In rural areas, diabetes prevalence was 14.3%, ranging from 8.4% in Colorado to 21.3% in North Carolina. In urban areas, the prevalence was 11.2%, ranging from 6.9% in Colorado to 15.5% in West Virginia. Unadjusted diabetes ORs in rural versus urban areas were significant (P < .05) and greater than 1 for 19 states. After adjusting for age, sex, race, and ethnicity, the ORs were significant and greater than 1 for 7 states (Florida, Illinois, Kentucky, Maryland, North Carolina, Oregon, and Virginia). With additional adjustment for education, income, and obesity status, diabetes ORs in rural versus urban areas remained significant and greater than 1 for 2 states (North Carolina and Oregon).

Our findings reveal significant geographic disparities in diabetes prevalence between rural and urban areas in 19 states. The differences in most states may have been explained by rural-urban differences in sociodemographic characteristics and obesity rates. Our findings could inform decision makers to identify effective ways to reduce rural-urban disparities within states.