title: Diabetes care and outcomes: disparities across rural America.
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.
authors.affiliation: 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. halen@mailbox.sc.edu
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Hale
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bennett
authors.forename: Janice C
authors.initials: JC
authors.lastname: Probst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration*; D014481:United States; D014504:Urban Health; D019037:Urban Health Services / Q000458:organization & administration; D055815:Young Adult
references.citation: Health Serv Res. 2006 Feb;41(1):79-102
references.pmid: 16430602
references.citation: Prev Chronic Dis. 2004 Jan;1(1):A07
references.pmid: 15634369
references.citation: J Health Soc Behav. 1995 Mar;36(1):1-10
references.pmid: 7738325
references.citation: Prev Chronic Dis. 2006 Jan;3(1):A15
references.pmid: 16356368
references.citation: Diabetes Care. 2002 Dec;25(12):2224-9
references.pmid: 12453965
references.citation: J Rural Health. 2006 Fall;22(4):351-8
references.pmid: 17010033
references.citation: BMC Health Serv Res. 2007 Mar 09;7:40
references.pmid: 17349050
references.citation: Fam Med. 2002 Sep;34(8):609-15
references.pmid: 12269538
references.citation: Diabetes Educ. 2006 Nov-Dec;32(6):963-7
references.pmid: 17102163
references.citation: Prev Med. 2005 Jul;41(1):79-84
references.pmid: 15916996
references.citation: Diabetes Care. 2001 Mar;24(3):561-87
references.pmid: 11289485
references.citation: Diabetes Educ. 2005 Mar-Apr;31(2):225-34
references.pmid: 15797851
references.citation: J Community Health. 2004 Feb;29(1):29-44
references.pmid: 14768933
references.citation: Ophthalmology. 2009 Aug;116(8):1515-21, 1521.e1-3
references.pmid: 19651311
references.citation: Prev Chronic Dis. 2005 Oct;2(4):A08
references.pmid: 16164812
references.citation: Health Qual Life Outcomes. 2008 Nov 07;6:95
references.pmid: 18992161
references.citation: Diabetes Educ. 2005 Nov-Dec;31(6):890-9
references.pmid: 16288096
references.citation: Prev Chronic Dis. 2006 Jan;3(1):A11
references.pmid: 16356364
references.citation: J Rural Health. 2009 Summer;25(3):247-52
references.pmid: 19566609
references.citation: Ann Intern Med. 2006 Apr 4;144(7):465-74
references.pmid: 16585660
references.citation: JAMA. 2002 Oct 16;288(15):1909-14
references.pmid: 12377092
references.citation: JAMA. 2003 Oct 8;290(14):1884-90
references.pmid: 14532317
references.citation: Am J Public Health. 2000 Mar;90(3):431-4
references.pmid: 10705866
references.citation: Ann Fam Med. 2004 Nov-Dec;2(6):563-8
references.pmid: 15576542
references.citation: Diabetes Care. 2008 Jan;31 Suppl 1:S12-54
references.pmid: 18165335
references.citation: Diabetes Educ. 2009 Jan-Feb;35(1):147-54
references.pmid: 19244570
references.citation: Diabetes Care. 2004 Jan;27(1):2-8
references.pmid: 14693957
references.citation: Prev Chronic Dis. 2006 Jul;3(3):A85
references.pmid: 16776886
references.citation: Diabetes Care. 2002 Nov;25(11):1946-51
references.pmid: 12401737
references.citation: Am J Public Health. 2004 Jan;94(1):66-70
references.pmid: 14713700
references.citation: Am J Prev Med. 2001 Aug;21(2):124-31
references.pmid: 11457632