Researchers study community factors related to diabetes

Diabetes is a major public health issue in Texas, with nearly 8 million people in the state projected to have the condition by 2040. Texas has one of the highest diabetes prevalence rates in the United States at more than 10 percent, so determining the individual and community level factors driving the growth of this disease is crucial. A community-based research approach has been used to find various factors associated with geographic variations in health outcomes. However, few studies have investigated county-level characteristics associated with diabetes prevalence.

In a new study published in the Population Health Management journal, Juha Baek and Jusung Lee, both doctoral students at the Texas A&M School of Public Health, along with colleagues from the Houston Methodist Research Institute in Houston, analyzed county-level data in Texas to determine how various factors are associated with diabetes prevalence.

In this study, the researchers used data from the Centers for Disease Control and Prevention on the prevalence of diabetes, obesity and physical inactivity; county-level social and environmental factors from the Department of Health and Human Services and food insecurity from the County Health Rankings program.

The researchers examined demographic/social factors in the county level including age, sex and race/ethnicity as well as rates of unemployment, poverty, insurance coverage and food insecurity. They also included a variable to indicate whether the county would be considered urban or rural and measured health care resources meant to help manage and treat diabetes, such as primary care physicians and nonphysician health care professionals.

“Our research found that rural areas, high prevalence of obesity and physical inactivity and low numbers of nonphysician health care professionals were associated with increased diabetes prevalence at the county level,” Baek said.

This research supports that rurality is strongly associated with diabetes prevalence as rural counties often lack diabetes education programs and other resources. Additionally, rural areas frequently have higher rates of obesity, fewer built environments that encourage and support physical activity and lower numbers of nonphysician health care professionals.

This study is one of the first to extensively include various community factors that might be associated with diabetes prevalence at the county level in Texas, and its findings have potential to inform policy decisions related to diabetes prevention.

For example, policy makers could shore up inadequate diabetes education in rural areas by using online education programs. In addition, improving built environments to make rural county residents more able to be physically active and promoting the crucial role of nonphysician health care professionals in diabetes education and management could lead to better outcomes.

The findings of this research also point to the need for more in-depth study of county-level characteristics and diabetes prevalence. The authors note a few limitations of their study. For example, county-level data do not necessarily reflect individuals’ characteristics related to diabetes prevalence. Also, because the study focused solely on data for Texas counties, it has limited generalizability outside of the state. Lastly, this study examined relationships between county-level factors and diabetes prevalence using a snapshot of data. To gain a better understanding of the associations noted in this study, future research will need to examine how these associations change over time.

“This study adds to the body of research on how rurality and related factors are associated with the rising prevalence of diabetes,” Baek said. “The better understanding of how county-level characteristics and diabetes prevalence interact provided by this study pave the way for further in-depth research and highlight areas where policy makers can improve the situation in Texas counties facing greater rates of diabetes.”