Comparison of Patients with Diabetes in Rural and Urban Populations

Socioeconomic status has always had an impact on patient outcomes. “Although national mortality rates have generally declined in the past few decades, the urban-rural disparity in life expectancy has widened, with greater improvements in urban areas than rural” (Mercado et al.). The study conducted by Mercado et al. analyzed data from patients with diabetes in rural and urban areas from 1999-2018. They specifically focused on four parameters: A1c, blood pressure, cholesterol, and smoking history (ABCS). Data for this study was collected from The National Health and Nutrition Examination Survey (NHANES). NHANES collects information every two years, and ten cycles were used for this study. Patient demographics that were considered were age, sex, and race/ethnicity. Other data points that were collected were education, poverty-to-income ratio, health insurance coverage, time since diabetes diagnosis, age at diabetes diagnosis, and BMI. 

The results of the study found that overall, from 1999-2018 there were no significant differences between the rural and urban population data. “However, there were significant socioeconomic and clinical disparities in the association between poor ABCS management and rural/urban residence” (Mercado et al., 2021). Patients with diabetes who live in an urban area were more likely to have an A1c >9.0%. Additionally, patients with diabetes tended to have a higher percentage of smokers in rural areas compared to urban areas. According to Mercado, “Adults with diagnosed diabetes in urban areas experienced greater improvements in BP and non-HDL cholesterol from 1999–2006 to 2013–2018 than their rural counterparts”. The limitations of this study are that these patients were self-reported. Therefore, the sample was not representative of the general population and hard to generalize. Also, patients were selected for inclusion only if there was not missing data from the NHANES survey. That significantly decreased the available sample size. Additionally, during the time this data was gathered response to NHANES surveys decreased by 80%.

The information gained from this survey showed that there was a disparity within diabetes specific criteria while not significant, it was evident. According to Mercado, “Clinical and public health professionals need to incorporate evidence-based approaches in addressing sociodemographic barriers to achieve better ABCS measures across the nation but especially in disproportionately affected groups living in urban and rural areas”. There was also a disparity when comparing comprehensive care criteria. From a provider perspective, care for co-occurring diseases should be emphasized to optimize care.

Practice Pearls:

• Comprehensive care is vital when treating patients from all backgrounds.
• Access to healthcare and beneficial resources is a social determinant of health.
• Diabetes care can and often does involve other co-morbid disease care.

Mercado, Carla I., et al. “Differences in U.s. Rural-Urban Trends in Diabetes Abcs, 1999–2018.” Diabetes Care, vol. 44, no. 8, 2021, pp. 1766–1773., doi:10.2337/dc20-0097. 

Author: Grace Behr, PharmD/MBA Candidate, Creighton University