Disparities in access to care, insurance coverage, health behaviors, and quality of diabetic care in the Delta region of the United States (2009)

Background: The Economic Development Administration has considered the Delta region of the U.S. the most distressed area of the country. The enabling legislation for the Delta Regional Authority allocates approximately $13 million in Delta funding. This study will examine differences in access to care, insurance coverage, health behaviors, and quality of diabetic care to understand how to address the needs of this distressed region. Methods: A cross-sectional design utilizing data from the 2009 Behavioral Risk Factor Surveillance System were linked with the 2009 Area Resource File (ARF) to examine geographic and race differences in access to care, health behaviors, and quality of diabetic care in the Delta region of the U.S. Rural-Urban Continuum codes in ARF were used to designate county level rurality. Bivariate analyses were conducted among variables using chi-square tests. The population consisted of 2009 self-report data from adults of the Delta region (183 counties; n=16,861), of which 44.7% rural and 55.3% urban, and Non-Delta rural (1087 counties; n=100,171), and non-Delta urban counties (966 counties; n=263,792) in the U.S. Results: Delta adults (21.4%) self-reported fair to poor health status compared to 18.2% non-Delta rural and 15.1% non-Delta urban (p<.05). Delta adults (18%) were more likely (p<0.05) to report being uninsured than non-Delta rural (17.1%) and non-Delta urban (14.8%). Delta adults (17.3%) were more likely (p<0.05) to report deferring care due to cost than non-Delta rural (15.5%) and non-Delta urban (14.6%). Delta adults were more likely (p<.05) to report being obese/overweight (69.3%) and less likely (p<0.05) to report physical activity (39.2%) than non-Delta rural (67.2%; 45.5%) and non-Delta urban (62.9%; 45.7%). Black and White Delta adults were more likely (p<.05) to self-report being obese/overweight and less likely to report any level of physical activity compared to non-Delta rural and urban. Delta adults (11.1%) were more likely (p<.05) to report differences in diabetes prevalence than non-Delta rural (9.9%) and non-Delta urban (8.7%).Delta adults self-report of annual diabetic exam was similar across geographic areas, but diabetic annual foot and dilated eye exams varied (p<.05) across geographic areas. Conclusion: For many indicators, Delta adults parallel other rural disparities: obesity and overweight among white and black adults, physical activity level, and quality-of-care measures. However, Delta adults fare worse than non-Delta rural and non-Delta urban in self-reported health status, insurance status, and diabetes. It is vital that these regional disparities remain at the forefront of policy in order to address this distressed region.