Department of Chronic Disease Epidemiology, Yale University, 60 College Street, New Haven, CT, 06510, USA.
Department of Biostatistics, Michigan School of Public Health, Ann Arbor, MI, USA.
BMC Public Health. 2019 Sep 26;19(1):1190. doi: 10.1186/s12889-019-7491-9.
Due to the high prevalence of diabetes risk factors in rural areas, it is important to identify whether differences in diabetes screening rates between rural and urban areas exist. Thus, the purpose of this study is to examine if living in a rural area, rurality, has any influence on diabetes screening across the US.
Participants from the 2011, 2013, 2015, and 2017 nationally representative Behavioral Risk Factor Surveillance System (BRFSS) surveys who responded to a question on diabetes screening were included in the study (n = 1,889,712). Two types of marginal probabilities, average adjusted predictions (AAPs) and average marginal effects (AMEs), were estimated at the national level using this data. AAPs and AMEs allow for the assessment of the independent role of rurality on diabetes screening while controlling for important covariates.
People who lived in urban, suburban, and rural areas all had comparable odds (Urban compared to Rural Odds Ratio (OR): 1.01, Suburbans compared to Rural OR: 0.95, 0.94) and probabilities of diabetes screening (Urban AAP: 70.47%, Suburban AAPs: 69.31 and 69.05%, Rural AAP: 70.27%). Statistically significant differences in probability of diabetes screening were observed between residents in suburban areas and rural residents (AMEs: - 0.96% and - 1.22%) but not between urban and rural residents (AME: 0.20%).
While similar levels of diabetes screening were found in urban, suburban, and rural areas, there is arguably a need for increased diabetes screening in rural areas where the prevalence of diabetes risk factors is higher than in urban areas.
由于农村地区糖尿病危险因素的高发率，确定城乡之间糖尿病筛查率是否存在差异很重要。因此，本研究旨在检验农村地区的居住环境（农村性）是否对美国各地的糖尿病筛查产生影响。
本研究纳入了来自 2011 年、2013 年、2015 年和 2017 年全国代表性行为风险因素监测系统（BRFSS）调查中回答了有关糖尿病筛查问题的参与者（n=1,889,712）。利用该数据，在全国范围内使用两种边缘概率，即平均调整预测值（AAP）和平均边缘效应值（AME）进行了估计。AAP 和 AME 允许在控制重要协变量的情况下，评估农村性对糖尿病筛查的独立作用。
居住在城市、郊区和农村地区的人都有类似的糖尿病筛查几率（城市与农村的比值比（OR）：1.01，郊区与农村的 OR：0.95，0.94）和概率（城市 AAP：70.47%，郊区 AAP：69.31%和 69.05%，农村 AAP：70.27%）。在郊区居民和农村居民之间观察到糖尿病筛查概率的统计学显著差异（AMEs：-0.96%和-1.22%），但在城市和农村居民之间没有（AME：0.20%）。
尽管在城市、郊区和农村地区发现了相似水平的糖尿病筛查，但农村地区的糖尿病风险因素患病率高于城市地区，因此可能需要增加糖尿病筛查。
