Differences in Diabetes Care Practices Between Rural and Urban Adults in the United States in 2017 Open Access

Ma, Siqi (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/bz60cx346?locale=en


Aims: There is evidence of disparities in diabetes-related health outcomes between those living in rural and urban counties of the U.S. This may in part be related to urban-rural disparities in the receipt of diabetes care practices. Our study examined differences in diabetes care practices across the urban-rural continuum in U.S. adults with diabetes for the year 2017.

Methods: Data were from the 2017 Behavioral Risk Factor Surveillance System telephone survey of 14,455 non-institutionalized adults with self-reported diagnosed diabetes with information on diabetes care and residence. Two types of diabetes care practices were considered: engagement with health care and self-management behaviors. Engagement practices included biannual health professional visits, biannual HbA1c tests, and an annual foot exam. Self-management indicators included diabetes education, daily glucose self-monitoring, daily foot checks, and monthly exercise. Place of residence was classified based on the respondent’s landline telephone number. Respondents in any a metropolitan statistical area (MSA) were considered urban, while respondents outside an MSA were considered rural. We estimated the prevalence of each care practice across the urban-rural continuum. We also conducted multiple logistic regression to estimate the association between residence (ref= urban) and each care practice, adjusting for race/ethnicity, sex, education, income, and age. Measures were stratified by race to account for potential effect modification.

Results: Compared to those living inside the center city of a metropolitan area, rural respondents had lower proportions of engagement in diabetes education (52.0% vs 59.5%) and annual foot exams (76.8% vs 79.9%). Despite differences in prevalence, adjusted and unadjusted analyses indicated no significant associations between place of residence and likelihood of optimal diabetes practices, besides among rural black adults, who had a significantly lower likelihood of participating in all diabetes care practices (OR= 0.46, p=0.009) and all self-management practices (OR=0.46, p=0.004).

Conclusion: Rural adults did not exhibit a significantly different likelihood of participation in any individual diabetes care practice indicators compared to urban adults. Black adults were the only group to exhibit significant rural disadvantage with respect to diabetes care, suggesting that race intersects with rurality in influencing healthcare access and behaviors. 

Table of Contents

Chapter I: Background/Literature Review.. 10

Chapter II. Manuscript 18

Abstract 18

Introduction. 19

Methods. 21

Results 26

Discussion. 30

References. 38

Tables. 44

Figures. 49

Chapter III: Summary, Public Health Implications, and Future Directions 55

Appendix. 57

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