Weingarten Joseph P, Brittman Susan, Hu Wenrong, Przybyszewski Chris, Hammond Judith M, FitzGerald Dawn
QSource, Memphis, TN 38115, USA.
J Rural Health. 2006 Fall;22(4):351-8. doi: 10.1111/j.1748-0361.2006.00057.x.
Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level.
To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities.
Medicare beneficiaries with diabetes aged 18-75 were identified from Part A and Part B claims data from 1999 to 2001. A composite of 3 diabetes care indicators was assessed (annual hemoglobin A1c test, biennial lipid profile, and biennial eye examination).
Over 77% had a hemoglobin A1c test, 74% a lipid profile, and 69% an eye examination. Patterns of care were considerably different across the urban-rural continuum at the state, Census division, and regional levels. States in the northern and eastern portions of the country had higher indicator rates for rural than for urban residents. States in the South had much lower rates for rural residents than their urban counterparts. Despite these within-state differences, across-state comparisons found that several states tended to have low indicator rates in every level of the urban-rural continuum. A common feature of these states was the relatively high concentration of nonwhite beneficiaries. For example, southern states had much higher concentrations of nonwhite beneficiaries relative to other areas in the country and demonstrated low rates in every level of the urban-rural continuum.
Urban-rural quality of care differences may be a function not just of geography but also of the presence of a large nonwhite population.
糖尿病给美国带来了日益沉重的健康负担，但迄今为止，大部分研究都是在州和地方层面进行的。
呈现为居住在城市、半农村和农村社区的医疗保险受益人提供的糖尿病护理的全国概况。
从1999年至2001年的A部分和B部分理赔数据中识别出年龄在18 - 75岁的患有糖尿病的医疗保险受益人。评估了3项糖尿病护理指标的综合情况（年度糖化血红蛋白检测、每两年一次的血脂检查和每两年一次的眼部检查）。
超过77%的人进行了糖化血红蛋白检测，74%的人进行了血脂检查，69%的人进行了眼部检查。在州、人口普查区和地区层面，城乡连续体上的护理模式差异很大。该国北部和东部各州农村居民的指标率高于城市居民。南部各州农村居民的指标率远低于城市居民。尽管存在州内差异，但跨州比较发现，几个州在城乡连续体的各个层面上指标率往往都很低。这些州的一个共同特征是非白人受益人的集中度相对较高。例如，南部各州相对于该国其他地区，非白人受益人的集中度要高得多，并且在城乡连续体的各个层面上指标率都很低。
城乡护理质量差异可能不仅是地理因素的作用，也是大量非白人人口存在的作用。
