Identifying potential predictors of Type 2 diabetes mellitus prevalence and incidence: a national county-level analysis Open Access

Carey, Tara Krystal (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/c534fp62z?locale=en
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Abstract

The seventh leading cause of death in the United States is diabetes mellitus, with 9.3% of the population having the condition, with rates continuing to increase. More than 90% of people diagnosed with diabetes have type 2 diabetes. The objective of this study is to identify social, economic, and built environment factors associated with both increasing and decreasing changes in diabetes prevalence and incidence at the county-level. This repeated cross-sectional ecologic study links 2009 and 2013 diabetes-related data from the Behavioral Risk Factor Surveillance System (BRFSS) to several county-level measures of the built environment and socioeconomic inequality. Data cover 3,137 US counties or county-equivalents. Outcome measures are the absolute change in diabetes prevalence and incidence. Candidate predictors include county-level obesity prevalence, physical inactivity prevalence, median income, poverty rate, access to parks, grocery stores per 1,000 persons, recreation and fitness facilities per 1,000 persons, and urbanization. Median income and poverty rate were also evaluated as potential effect modifiers. Sixty-eight percent (68%) of counties experienced increased diabetes prevalence. High-income counties have lower obesity prevalence, higher prevalence of physical activity, and greater access to parks compared to low-income counties. High-poverty counties were more obese, had fewer grocery stores, and had fewer recreation and fitness facilities compared to low-poverty counties. Diabetes increased most in counties with higher physical inactivity prevalence at baseline, fewer grocery stores, and fewer recreation and fitness facilities. Physical inactivity was associated with worsening diabetes incidence. Large central metro counties have better behavioral, economic, and environmental risk profiles. In conclusion, the findings suggest that behavioral and built environment factors are associated with changes in diabetes prevalence and incidence.

Table of Contents

Chapter I: Background/ Literature Review..............................................................1

Chapter II: Manuscript

Introduction...............................................................................................14

Methods....................................................................................................15

Results......................................................................................................20

Discussion..................................................................................................24

References.................................................................................................29

Tables

Tables 1-4..................................................................................................35

Figures

Figure 1.....................................................................................................39

Chapter III: Summary, Public Health Implications, & Possible Future Directions............42

Appendix

Additional tables..........................................................................................45

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