title: The relationship between county-level contextual characteristics and use of diabetes care services.
abstract: OBJECTIVE
  To examine the relationship between county-level measures of social determinants and use of preventive care among US adults with diagnosed diabetes. To inform future diabetes prevention strategies.
  
  
  METHODS
  Data are from the Behavioral Risk Factor Surveillance System (BRFSS) 2004 and 2005 surveys, the National Diabetes Surveillance System, and the Area Resource File. Use of diabetes care services was defined by self-reported receipt of 7 preventive care services. Our study sample included 46 806 respondents with self-reported diagnosed diabetes. Multilevel models were run to assess the association between county-level characteristics and receipt of each of the 7 preventive diabetes care service after controlling for characteristics of individuals. Results were considered significant if P < .05.
  
  
  RESULTS
  Controlling for individual-level characteristics, our analyses showed that 7 of the 8 county-level factors examined were significantly associated with use of 1 or more preventive diabetes care services. For example, people with diabetes living in a county with a high uninsurance rate were less likely to have an influenza vaccination, visit a doctor for diabetes care, have an A1c test, or a foot examination; people with diabetes living in a county with a high physician density were more likely to have an A1c test, foot examination, or an eye examination; and people with diabetes living in a county with more people with less than high-school education were less likely to have influenza vaccination, pneumococcal vaccination, or self-care education (all P < .05).
  
  
  CONCLUSIONS
  Many of the county-level factors examined in this study were found to be significantly associated with use of preventive diabetes care services. County policy makers may need to consider local circumstances to address the disparities in use of these services.
authors: Oak Ridge Institute for Science and Education (ORISE) Fellow, Office for State, Tribal, Local, and Territorial Support (OSTLTS), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia (Dr. Luo); OSTLTS, CDC (Dr. Sotnikov); Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC (Drs. Beckles, Zhang, Thompson, and Bardenheier).
authors: Huabin
authors: H
authors: Luo
authors: Gloria L A
authors: GL
authors: Beckles
authors: Xinzhi
authors: X
authors: Zhang
authors: Sergey
authors: S
authors: Sotnikov
authors: Ted
authors: T
authors: Thompson
authors: Barbara
authors: B
authors: Bardenheier
mesh_terms: D040343:Behavioral Risk Factor Surveillance System; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data*
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