Adults with diabetes who live in remote/rural areas and small towns are more likely than people in urban areas to experience one of nine types of diabetes complications. Small town residents had higher risk for eight complications ranging from heart attack, heart failure, end-stage kidney disease, vascular problems, and blood sugar emergencies. Rural residents had higher risk for heart attack and need for revascularization surgery to restore blocked blood flow (such as vascular bypass or angioplasty). The risk of retinopathy and atrial fibrillation/flutter did not vary geographically.
The analysis was based on medical claims for nearly 3 million adults in the United States. About 3% lived in remote areas with less than 2,500 population; 14% lived in small towns with population between 2,500 and 50,000, and 83% lived in urban areas with more than 50,000 population. The researchers compared the risks of diabetes outcomes by geographic region.
- Remote residents, compared to urban residents, had a 6% higher risk of myocardial infarction (heart attack), and a 4% higher risk of undergoing a revascularization procedure, but a 10% lower risk of hyperglycemia, and 9% lower risk of stroke.
- Small town residents, compared to urban residents were 6% more likely to experience severe hyperglycemia, 15% more likely to experience severe hypoglycemia (such as diabetic ketoacidosis), 4% more likely to have end-stage kidney disease, 10% more likely to have a heart attack, 5% more likely to have heart failure, 5% more likely to need an amputation, 2% more likely to have other complications affecting lower extremities, and 5% higher risk of undergoing a revascularization procedure. Small town residents had a 5% lower risk of stroke.
- Remote residents compared to small town residents had a 15% lower risk of severe hyperglycemia, 8% lower risk of severe hypoglycemia, and 6% lower risk of heart failure.
These findings were reported in “Disparities In Acute And Chronic Complications Of Diabetes Along The U.S. Rural-Urban Continuum” by Kyle Steiger; Jeph Herrin; Kavya Sindhu Swarna; Esa M. Davis; and Rozalina G. McCoy. The researchers analyzed data from the OptumLabs Data Warehouse, a deidentified data set of U.S. commercial and Medicare Advantage beneficiaries to conduct a retrospective cohort study. They followed 2.9 million adults age 18 and older with diabetes who were included in the database between January 1, 2012 and December 31, 2021. The analysis focused on the risk of developing diabetes complications based on residential density.
For more information, contact: Rozalina McCoy, Associate Professor, Director, Precision Medicine and Population Health Program for the University of Maryland Institute for Health Computing (UM-IHC) and Associate Division Chief for Clinical Research, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, Maryland 21201; Email: rozalina.mccoy@som.umaryland.edu; Website: https://www.medschool.umaryland.edu/profiles/mccoy-rozalina/