title: Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004-2012.
abstract: Recent studies suggest that prevalence of diagnosed diabetes in the United States reached a plateau or slowed around 2008, and that this change coincided with obesity plateaus and increases in physical activity. However, national estimates can obscure important variations in geographic subgroups. We examine whether a slowing or leveling off in diagnosed diabetes, obesity, and leisure time physical inactivity prevalence is also evident across the 3143 counties of the United States. We used publicly available county estimates of the age-adjusted prevalence of diagnosed diabetes, obesity, and leisure-time physical inactivity, which were generated by the Centers for Disease Control and Prevention (CDC). Using a Bayesian multilevel regression that included random effects by county and year and applied cubic splines to smooth these estimates over time, we estimated the average annual percentage point change (APPC) from 2004 to 2008 and from 2008 to 2012 for diabetes, obesity, and physical inactivity prevalence in each county. Compared to 2004-2008, the median APPCs for diabetes, obesity, and physical inactivity were lower in 2008-2012 (diabetes APPC difference = 0.16, 95%CI 0.14, 0.18; obesity APPC difference = 0.65, 95%CI 0.59, 0.70; physical inactivity APPC difference = 0.43, 95%CI 0.37, 0.48). APPCs and APPC differences between time periods varied among counties and U.S. regions. Despite improvements, levels of these risk factors remained high with most counties merely slowing rather than reversing, which suggests that all counties would likely benefit from reductions in these risk factors. The diversity of trajectories in the prevalence of these risk factors across counties underscores the continued need to identify high risk areas and populations for preventive interventions. Awareness of how these factors are changing might assist local policy makers in targeting and tracking the impact of efforts to reduce diabetes, obesity and physical inactivity.
authors.affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
authors.forename: Linda S
authors.identifier: http://orcid.org/0000-0001-9523-267X
authors.initials: LS
authors.lastname: Geiss
authors.affiliation: Northrop Grumman Corporation, Atlanta, Georgia, United States of America.
authors.forename: Karen
authors.initials: K
authors.lastname: Kirtland
authors.affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
authors.forename: Ji
authors.initials: J
authors.lastname: Lin
authors.affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
authors.forename: Sundar
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
authors.forename: Ted
authors.initials: T
authors.lastname: Thompson
authors.affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
authors.forename: Ann
authors.initials: A
authors.lastname: Albright
authors.affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
mesh_terms: D001499:Bayes Theorem; D040343:Behavioral Risk Factor Surveillance System; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000266:history; D015444:Exercise; D062306:Geography, Medical; D049674:History, 21st Century; D006801:Humans; D009765:Obesity / Q000453:epidemiology* / Q000266:history; D015995:Prevalence; D014481:United States / Q000453:epidemiology