Assessing Geographic Disparities in Prevalence of Prediabetes: A Spatial Epidemiological Investigation in Florida, 2013

Background: Prediabetes is a condition where a person has a blood glucose level higher than normal (A1C 5.7% to 6.4%) but not high enough for a diagnosis of diabetes. Individuals with prediabetes are at an increased risk for developing Type 2 diabetes, heart disease, and stroke. Risk factors for developing prediabetes include age, obesity, hypertension and family history of diabetes. Lifestyle change programs can help individuals with prediabetes prevent diabetes. Previously, no studies have investigated geographic disparities of prediabetes and associated risk factors in Florida. Identifying geographic areas and population groups with increased burden of prediabetes is important for informing public health policy, intervention and prevention efforts. The objectives of this study were to investigate geographic disparities of prediabetes prevalence and associated risk factors and identify areas with statistically higher burden of prediabetes.

Methods: Behavioral Risk Factor Surveillance System data were obtained from the Florida Department of Health. Statistical analyses were performed using SAS 9.4. To assess geographic disparities, Geographical Information System (GIS) technology was used to develop chloropleth maps.  Global Moran’s I was used to detect clustering of prediabetes prevalence.  Local indicators of spatial association (LISA) were used to identify counties with significantly high prevalence proportions of prediabetes.

Results: There were approximately (7.15%) 1,090,660 adults in Florida diagnosed with prediabetes in 2013. Results indicate that many rural counties throughout the state tended to have higher prediabetes prevalence compared to urban areas. Prediabetes prevalence proportions were typically higher in counties without Lifestyle change programs. Hotspots prevalence of prediabetes were identified in the north while areas with significantly low prevalence proportions were identified in the south which also tended to have Lifestyle change programs. Individuals that were obese were two times more likely to have a diagnosis of prediabetes.

 

Conclusion: There is evidence of geographic disparities of prediabetes prevalence in Florida which drastically impacts the health of many Floridians. There is a need to continue to identify areas and populations with higher risks of prediabetes so as to help inform public health policies to strategically guide prevention efforts. The Florida Department of Health Bureau of Chronic Disease Prevention is working to increase physician referrals to Lifestyle change programs.