Diabetes and related comorbidities among rural Medicare beneficiaries: Findings from the Medical Expenditure Panel Survey

Problem Statement: Diabetes mellitus affects 26 million Americans, and costs the nation an average of $174 billion per year. A previous study (Howard et al, 2014) showed rural Medicare beneficiaries were less likely to have diabetes. However, rural diabetic beneficiaries were three times more likely to have comorbidities. Using Medical Expenditure Panel Survey (MEPS), this study models the effects of rural residence on diabetes and related cardiometabolic conditions.

Methods: Disease diagnosis outcome variables were drawn from the 2004-2011 MEPS Household Component files. Separate logistic regressions were used for beneficiaries and the overall population to model the impact of rural residence on: (1) prevalence of diabetes or other diabetes-related cardiometabolic diagnoses, (2) prevalence of diabetes-related cardiometabolic diseases among diabetics, and (3) incidence of diabetes. Diabetes-related comorbidities in MEPS included hypertension, coronary heart disease, stroke or transient ischemic attack, high cholesterol, diabetes-related eye or kidney disease, angina, and heart attack.

Results: Among beneficiaries and the broader population, rural residence was significantly related to the three disease states previously enumerated.  Rural diabetics were nearly 3 times more likely to have related comorbidities.

Conclusions: Rural residence was associated with lower prevalence of diabetes and related cardiometabolic conditions.  It may be that rural lifestyles are more active, contributing to lower disease burdens, or that reduced access to primary care leaves more rural diabetics undiagnosed.  Increased prevalence of related comorbidities among rural diabetics may be influenced by decreased access to primary care and disease management programs.  Future studies should control for access to these services.