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APHA Scientific Session and Event Listing

Recorded presentation

Kathleen Gillespie, PhD and Santosh Krishna, PhD. School of Public Health, Saint Louis University, Department of Health Management and Policy, 3545 Lafayette Avenue, Saint Louis, MO 63104, 3149778147, gilleskn@slu.edu

The purpose of this study is to determine if rural populations, when compared to urban populations, differ in the prevalence of diabetes, health care received, and in diabetes related health care resource utilization Diabetes and related complications cost billions of dollars in direct and indirect costs of providing health care to 18 million people in the United States annually. Almost 75% of rural counties have areas within them designated as Medically Underserved Areas. One out of every two rural elderly feels that they do not have readily available information about diabetes and other chronic disorders. Using two years of data from the Behavioral Risk Factor Surveillance System (BRFSS) we estimate the prevalence of diabetes and compliance with care guidelines by urban and rural status. The BRFSS is a cross-sectional telephone survey conducted by state health departments with technical and methodologic assistance provided by the Centers for Disease Control and Prevention (CDC). The 2002 BRFSS data set has 247,959 valid total records with 18,779 (7.6%) diagnosed with diabetes. Descriptive statistics are used to compare the prevalence rates of diabetes across different rural and urban areas. Urban Influence Codes (UIC), a 12 unit scale of the degree of rurality, are used to categorize respondents. After determining the prevalence of diabetes, we look at the distribution of risk factors, such as race, older age, and higher body-mass index across the UICs. Next we examine the degree of compliance with standards of care for diabetes, such as annual eye examinations and HbA1c testing. We use logistic regression to adjust the prevalence of diabetes by rural status and known risk factors. We also estimate compliance with standards of care using logistic regression to estimate compliance with each recommendation and multivariate regression to estimate compliance as a scale. The overall prevalence of diabetes as reported in the BRFSS exceeds other national estimates of diabetes prevalence. Within the BRFSS data, the prevalence of diabetes varies over the 12 UIC codes, with slightly lower rates in rural areas. However, rural areas have more elderly people and fewer persons with normal body-mass indices, both indicating a greater risk for diabetes. This project has major policy and practice implications for the health of rural populations diagnosed with diabetes or at risk for diabetes.

Learning Objectives:

• Participants will learn
• · different measures of rural-ness
• · the prevalence of diabetes in rural and urban areas as identified in a large national sample
• · how compliance with care guidelines for diabetes differ by urban/rural status
• · the extent to which these urban/rural differences are explained by demographic and access to care factors

Keywords: Diabetes, Rural Health

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation