Small area variation in diabetes prevalence in Puerto Rico.
OBJECTIVE
To estimate the 2009 prevalence of diagnosed diabetes in Puerto Rico among adults ≥ 20 years of age in order to gain a better understanding of its geographic distribution so that policymakers can more efficiently target prevention and control programs.


METHODS
A Bayesian multilevel model was fitted to the combined 2008-2010 Behavioral Risk Factor Surveillance System and 2009 United States Census data to estimate diabetes prevalence for each of the 78 municipios (counties) in Puerto Rico.


RESULTS
The mean unadjusted estimate for all counties was 14.3% (range by county, 9.9%-18.0%). The average width of the confidence intervals was 6.2%. Adjusted and unadjusted estimates differed little.


CONCLUSIONS
These 78 county estimates are higher on average and showed less variability (i.e., had a smaller range) than the previously published estimates of the 2008 diabetes prevalence for all United States counties (mean, 9.9%; range, 3.0%-18.2%).
United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA. ext5@cdc.gov
Edward F
EF
Tierney
Nilka R
NR
Burrows
Lawrence E
LE
Barker
Gloria L
GL
Beckles
James P
JP
Boyle
Betsy L
BL
Cadwell
Karen A
KA
Kirtland
Theodore J
TJ
Thompson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011647:Puerto Rico / Q000453:epidemiology; D017062:Small-Area Analysis; D055815:Young Adult