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Diabetes Care and Outcomes: Disparities Across Rural America

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Abstract

We examined differences in receipt of diabetes care and selected outcomes between rural and urban persons living with diabetes, using nationally representative data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS). “Rural” was defined as living in a non-metropolitan county. Diabetes care variables were physician visit, HbA1c testing, foot examination, and dilated eye examination. Outcome variables were presence of foot sores and diabetic retinopathy. Analysis was limited to persons 18 and older self-reporting a diagnosis of diabetes (n = 29,501). A lower proportion of rural than urban persons with diabetes reported a dilated eye examination (69.1 vs. 72.4%; P = 0.005) or a foot examination in the past year (70.6 vs. 73.7%; P = 0.016). Conversely, a greater proportion of rural than urban persons reported diabetic retinopathy (25.8 vs. 22.0%; P = 0.007) and having a foot sore taking more than four weeks to heal (13.2 vs. 11.2%; P = 0.036). Rural residence was not associated with receipt of services after individual characteristics were taken into account in adjusted analysis, but remained associated with an increased risk for retinopathy (OR = 1.20, 95% CI = 1.02–1.42). Participation in Diabetes Self-Management Education (DSME) was positively associated with all measures of diabetes care included in the study. Availability of specialty services and travel considerations could explain some of these differences.

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References

  1. Narayan, K. M., Boyle, J. P., Thompson, T. J., Sorensen, S. W., & Williamson, D. F. (2003). Lifetime risk for diabetes mellitus in the United States. Journal of the American Medical Association, 290(14), 1884–1890.

    Article  CAS  PubMed  Google Scholar 

  2. Johnson, E. A., Webb, W. L., McDowall, J. M., et al. (2005). A field-based approach to support improved diabetes care in rural states. Preventing Chronic Disease, 2(4), A08.

    PubMed  Google Scholar 

  3. American Diabetes Association. (2008). Standards of Medical Care in Diabetes. Diabetes Care, 31(Suppl 1), S12–S54.

    Article  Google Scholar 

  4. Lee, J. A., Liu, C. F., & Sales, A. E. (2006). Racial and ethnic differences in diabetes care and health care use and costs. Preventing Chronic Disease, 3(3), A85.

    PubMed  Google Scholar 

  5. Mainous, A. G., 3rd, King, D. E., Garr, D. R., & Pearson, W. S. (2004). Race, rural residence, and control of diabetes and hypertension. Annals of Family Medicine, 2(6), 563–568.

    Article  PubMed  Google Scholar 

  6. Mukhtar, Q., Jack, L., Jr., Martin, M., Murphy, D., & Rivera, M. (2006). Evaluating progress toward Healthy People 2010 national diabetes objectives. Preventing Chronic Disease, 3(1), A11.

    Article  PubMed  Google Scholar 

  7. Phillips, M. M. (2004). Targeting diabetes preventive care programs: insights from the 2001 Behavioral Risk Factor Surveillance Survey. Preventing Chronic Disease, 1(1), A07.

    PubMed  Google Scholar 

  8. Saaddine, J. B., Cadwell, B., Gregg, E. W., Engelgau, M. M., Vinicor, F., Imperatore, G., et al. (2006). Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002. Annals of Internal Medicine, 144(7), 465–474.

    PubMed  Google Scholar 

  9. Pathman, D. E., Ricketts, T. C., 3rd, & Konrad, T. R. (2006). How adults’ access to outpatient physician services relates to the local supply of primary care physicians in the rural southeast. Health Services Research, 41(1), 79–102.

    Article  PubMed  Google Scholar 

  10. Andrus, M. R., Kelley, K. W., Murphey, L. M., & Herndon, K. C. (2004). A comparison of diabetes care in rural and urban medical clinics in Alabama. Journal of Community Health, 29(1), 29–44.

    Article  PubMed  Google Scholar 

  11. Bell, R. A., Camacho, F., Goonan, K., Duren-Winfield, V., Anderson, R. T., Konen, J. C., et al. (2001). Quality of diabetes care among low-income patients in North Carolina. American Journal of Preventive Medicine, 21(2), 124–131.

    Article  CAS  PubMed  Google Scholar 

  12. Chin, M. H., Auerbach, S. B., Cook, S., et al. (2000). Quality of diabetes care in community health centers. American Journal of Public Health, 90(3), 431–434.

    Article  CAS  PubMed  Google Scholar 

  13. Coon, P., & Zulkowski, K. (2002). Adherence to American Diabetes Association standards of care by rural health care providers. Diabetes Care, 25(12), 2224–2229.

    Article  PubMed  Google Scholar 

  14. Kirkman, M. S., Williams, S. R., Caffrey, H. H., & Marrero, D. G. (2002). Impact of a program to improve adherence to diabetes guidelines by primary care physicians. Diabetes Care, 25(11), 1946–1951.

    Article  PubMed  Google Scholar 

  15. Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving primary care for patients with chronic illness: The chronic care model, part 2. Journal of the American Medical Association, 288(15), 1909–1914.

    Article  PubMed  Google Scholar 

  16. Norris, S. L., Engelgau, M. M., & Narayan, K. M. (2001). Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care, 24(3), 561–587.

    Article  CAS  PubMed  Google Scholar 

  17. Strine, T. W., Okoro, C. A., Chapman, D. P., Beckles, G. L., Balluz, L., & Mokdad, A. H. (2005). The impact of formal diabetes education on the preventive health practices and behaviors of persons with type 2 diabetes. Preventive Medicine, 41(1), 79–84.

    Article  PubMed  Google Scholar 

  18. Balamurugan, A., Rivera, M., Jack, L., Jr., Allen, K., & Morris, S. (2006). Barriers to diabetes self-management education programs in underserved rural Arkansas: Implications for program evaluation. Preventing Chronic Disease, 3(1), A15.

    PubMed  Google Scholar 

  19. Butcher, M. K., Gilman, J., Meszaros, J. F., Bjorsness, D., Madison, M., McDowall, J. M., et al. (2006). Improving access to quality diabetes education in a rural state: The Montana Quality Diabetes Education Initiative. The Diabetes Educator, 32(6), 963–967.

    Article  PubMed  Google Scholar 

  20. Powell, M. P., Glover, S. H., Probst, J. C., & Laditka, S. B. (2005). Barriers associated with the delivery of Medicare-reimbursed diabetes self-management education. The Diabetes Educator, 31(6), 890–899.

    Article  PubMed  Google Scholar 

  21. Economic Research Service. (2008). Urban Influence Codes. U.S. Department of Agriculture. At http://www.ers.usda.gov/Briefing/Rurality/UrbanInf. Accessed: April 2008.

  22. Economic Research Service. (2008). Measuring rurality: New definitions in 2003. U.S. Department of Agriculture. At: http://www.ers.usda.gov/Briefing/Rurality/NewDefinitions. Accessed: April 2008.

  23. Anderson, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1–10.

    Article  Google Scholar 

  24. US Health Resources and Services Administration. (1993). Criteria for designation of areas having shortages of primary medical care professionals. In Relevant excerpts from 42 code of federal regulations (CFR), Chap. 1, Part 5, Appendix A (pp. 34–48).

  25. Mainous, A. G., 3rd, Koopman, R. J., Gill, J. M., Baker, R., & Pearson, W. S. (2004). Relationship between continuity of care and diabetes control: Evidence from the Third National Health and Nutrition Examination Survey. American Journal of Public Health, 94(1), 66–70.

    Article  PubMed  Google Scholar 

  26. Probst, J. C., Laditka, S. B., Wang, J. Y., & Johnson, A. O. (2007). Effects of residence and race on burden of travel for care: Cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Services Research, 7, 40.

    Article  PubMed  Google Scholar 

  27. Weingarten, J. P., Jr., Brittman, S., Hu, W., Przybyszewski, C., Hammond, J. M., & FitzGerald, D. (2006). The state of diabetes care provided to Medicare beneficiaries living in rural America. Journal of Rural Health, 22(4), 351–358.

    Article  PubMed  Google Scholar 

  28. US Department of Health and Human Services. (2000). Understanding and improving health and objectives for improving health. In Healthy people 2010 (2nd ed.). Washington, DC: U.S. Government Printing Office.

  29. Sloan, F. A., Grossman, D. S., & Lee, P. P. (2009). Effects of receipt of guideline-recommended care on onset of diabetic retinopathy and its progression. Ophthalmology, 116(8), 1515–1521, e1511–1513.

    Google Scholar 

  30. Matza, L. S., Rousculp, M. D., Malley, K., Boye, K. S., & Oglesby, A. (2008). The longitudinal link between visual acuity and health-related quality of life in patients with diabetic retinopathy. Health and Quality of Life Outcomes, 6, 95.

    Article  PubMed  Google Scholar 

  31. Probst, J. C., Moore, C. G., Baxley, E. G., & Lammie, J. J. (2002). Rural-urban differences in visits to primary care physicians. Family Medicine, 34(8), 609–615.

    PubMed  Google Scholar 

  32. Kirkbride, K., & Wallace, N. (2009). Rural health clinics and diabetes-related primary care for medicaid beneficiaries in Oregon. Journal of Rural Health, 25(3), 247–252.

    Article  PubMed  Google Scholar 

  33. Chin, M. H., Cook, S., Drum, M. L., Jin, L., et al. (2004). Improving diabetes care in midwest community health centers with the health disparities collaborative. Diabetes Care, 27(4), 2–8.

    Article  PubMed  Google Scholar 

  34. Siminerio, L. M., Piatt, G., & Zgibor, J. C. (2005). Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice. The Diabetes Educator, 31(2), 225–234.

    Article  PubMed  Google Scholar 

  35. Balamurugan, A., Hall-Barrow, J., Blevins, M. A., et al. (2009). A pilot study of diabetes education via telemedicine in a rural underserved community—opportunities and challenges: A continuous quality improvement process. The Diabetes Educator, 35(1), 147–154.

    Article  PubMed  Google Scholar 

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Acknowledgments

The research reported here was supported in part by grant no U1CRH03711from the Office of Rural Health Policy, USDHHS.

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Authors and Affiliations

  1. Department of Health Services Policy and Management, Arnold School of Public Health, South Carolina Rural Health Research Center, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC, 29208, USA

    Nathan L. Hale & Janice C. Probst

  2. Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC, 29203, USA

    Kevin J. Bennett

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  1. Nathan L. Hale
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Correspondence to Nathan L. Hale.

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Hale, N.L., Bennett, K.J. & Probst, J.C. Diabetes Care and Outcomes: Disparities Across Rural America. J Community Health 35, 365–374 (2010). https://doi.org/10.1007/s10900-010-9259-0

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