Rural people have long been more likely to die from diabetes; now the disparity seems to be increasing

Annual diabetes death rates per 100,000 people, for diabetes as a multiple cause of death and for diabetes as an underlying cause of death. (Mayo Clinic graph from Centers for Disease Control data; click on it for a larger version)

Diabetes comes with lifelong care and an extensive list of possible complications, which range from eye problems to foot problems to kidney problems, gum disease and cancer. A Mayo Clinic study has found that rural counties have higher diabetes death rates, and the disparity seems to be increasing. "The researchers point out that these rural health trends would not be visible in an analysis of national-level data," the National Institute on Minority Health and Health Disparities reports. "Large declines in diabetes mortality in recent decades in more urbanized counties have resulted in national-level declines in ADMR, masking the health disparities present in rural counties."

NIMHS reports, "Using data from the Centers for Disease Control and Prevention, researchers compared the annual diabetes mortality rate per 100,000 people in 2017-2018 with the rate in 1999-2000. This mortality rate includes deaths where diabetes is listed as one of multiple causes." Rural death rates rose slightly, but fell in urbanized counties, "showing that people in rural areas were not experiencing whatever factor accounted for the decrease in more urbanized areas. . . . Rural health disparities in diabetes were a consistent theme across all groups."

While the study showed that rural people are more likely to die from diabetes, it did not isolate causes. "The researchers suggest several possible reasons why people in rural areas may be more likely to die from diabetes. People in rural areas may be more likely to have other medical conditions that could make their diabetes worse. They may have difficulty accessing health care and may not consume as many fruits and vegetables as people in urban areas do. They may also be disproportionately affected by environmental pollution," NIMHS reports. "The researchers write that further research could show why these disparities exist and support development of ways to improve rural health."

The study, "Assessment of disparities in diabetes mortality in adults in U.S. rural vs. non-rural counties, 1999-2018," was published in JAMA Network Open, a publication of the American Medical Association.