title: Adequacy of diabetes care for older U.S. rural adults: a cross-sectional population based study using 2009 BRFSS data.
abstract: BACKGROUND
  In the U.S. diabetes prevalence estimates for adults ≥ 65 years exceed 20%. Rural communities have higher proportions of older individuals and health disparities associated with rural residency place rural communities at risk for a higher burden from diabetes. This study examined the adequacy of care received by older rural adults for their diabetes to determine if older rural adults differed in the receipt of adequate diabetes care when compared to their non-rural counterparts.
  
  
  METHODS
  Cross-sectional data from the 2009 Behavioral Risk Factor Surveillance Survey were examined using bivariate and multivariate analytical techniques.
  
  
  RESULTS
  Logistic regression analysis revealed that older rural adults with diabetes were more likely to receive less than adequate care when compared to their non-rural counterparts (OR = 1.465, 95% CI: 1.454-1.475). Older rural adults receiving less than adequate care for their diabetes were more likely to be: male, non-Caucasian, less educated, unmarried, economically poorer, inactive, a smoker. They were also more likely to: have deferred medical care because of cost, not have a personal health care provider, and not have had a routine medical check-up within the last 12 months.
  
  
  CONCLUSIONS
  There are gaps between what is recommended for diabetes management and the management that older individuals receive. Older adults with diabetes living in rural communities are at greater risk for less than adequate care when compared to their non-rural counterparts. These results suggest the need to develop strategies to improve diabetes care for older adults with diabetes and to target those at highest risk.
authors.affiliation: Essentia Institute of Rural Health, Research Division, Duluth, MN 55805, USA. mlutfiyya@eirh.org
authors.forename: M Nawal
authors.initials: MN
authors.lastname: Lutfiyya
authors.forename: Joel E
authors.initials: JE
authors.lastname: McCullough
authors.forename: Lori
authors.initials: L
authors.lastname: Mitchell
authors.forename: L Scott
authors.initials: LS
authors.lastname: Dean
authors.forename: Martin S
authors.initials: MS
authors.lastname: Lipsky
mesh_terms: D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards; D012424:Rural Population; D014481:United States