title: Geographic distribution of childhood diabetes and obesity relative to the supply of pediatric endocrinologists in the United States.
abstract: OBJECTIVE
  To determine the geographic distribution of childhood diabetes and obesity relative to the supply of US pediatric endocrinologists.
  
  
  METHODS
  Estimation of observed and "index" ratios of children with diabetes (by region and division) and obesity (body mass index >/=95th % for age and sex) (by region and state) to board-certified pediatric endocrinologists.
  
  
  RESULTS
  At the national level, the ratio of children with diabetes to pediatric endocrinologists is 290:1, and the ratio of obese children to pediatric endocrinologists is 17,741:1. Ratios of children with diabetes to pediatric endocrinologists in the Midwest (370:1), South (335:1), and West (367:1) are twice as high as in the Northeast (144:1). Across states, there is up to a 19-fold difference in the observed ratios of obese children to pediatric endocrinologists. Under conditions of equitably distributed endocrinologist supply, variation across states would be mitigated considerably.
  
  
  CONCLUSIONS
  The distribution of children with diabetes and obesity does not parallel the distribution of pediatric endocrinologists in the United States, due largely to geographic disparities in endocrinologist supply. Given the large burden of obese children to endocrinologists, multidisciplinary models of care delivery are essential for the US health care system to address the needs of children with diabetes and obesity.
authors.affiliation: Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Lee
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Ram K
authors.initials: RK
authors.lastname: Menon
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003710:Demography; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004704:Endocrinology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D010372:Pediatrics; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D000078329:Workforce