Emergency Medicine, New York University School of Medicine, New York, New York, USA
Population Health, New York University School of Medicine, New York, New York, USA.
BMJ Open. 2024 Aug 6;14(8):e080831. doi: 10.1136/bmjopen-2023-080831.
To perform a detailed characterisation of diabetes burden and pre-diabetes risk in a rural county with previously documented poor health outcomes in order to understand the local within-county distribution of diabetes in rural areas of America.
DESIGN, SETTING, AND PARTICIPANTS: In 2021, we prospectively mailed health surveys to all households in Sullivan County, a rural county with the second-worst health outcomes of all counties in New York State. Our survey included questions on demographics, medical history and the American Diabetes Association's Pre-diabetes Risk Test.
Our primary outcome was an assessment of diabetes burden within this rural county. To help mitigate non-response bias in our survey, raking adjustments were performed across strata of age, sex, race/ethnicity and health insurance. We analysed diabetes prevalence by demographic characteristics and used geospatial analysis to assess for clustering of diagnosed diabetes cases.
After applying raking procedures for the 4725 survey responses, our adjusted diagnosed diabetes prevalence for Sullivan County was 12.9% compared with the 2019 Behavioural Risk Factor Surveillance System (BRFSS) estimate of 8.6%. In this rural area, diagnosed diabetes prevalence was notably higher among non-Hispanic Black (21%) and Hispanic (15%) residents compared with non-Hispanic White (12%) residents. 53% of respondents without a known history of pre-diabetes or diabetes scored as high risk for pre-diabetes. Nearest neighbour analyses revealed that hotspots of diagnosed diabetes were primarily located in the more densely populated areas of this rural county.
Our mailed health survey to all residents in Sullivan County demonstrated higher diabetes prevalence compared with modelled BRFSS estimates that were based on small telephone samples. Our results suggest the need for better diabetes surveillance in rural communities, which may benefit from interventions specifically tailored for improving glycaemic control among rural residents.
对一个先前健康状况不佳的农村县的糖尿病负担和糖尿病前期风险进行详细描述，以了解美国农村地区糖尿病在当地的县内分布情况。
设计、地点和参与者：2021 年，我们前瞻性地向沙利文县（纽约州所有县中健康状况第二差的县）的所有家庭邮寄了健康调查。我们的调查包括人口统计学、病史和美国糖尿病协会的糖尿病前期风险测试。
我们的主要结果是评估该县农村地区的糖尿病负担。为了减轻我们调查中的无回应偏差，我们在年龄、性别、种族/族裔和医疗保险等各个层次上进行了耙调整。我们根据人口统计学特征分析了糖尿病的流行情况，并使用地理空间分析评估了确诊糖尿病病例的聚类情况。
在对 4725 份调查回复进行耙处理后，我们调整后的沙利文县确诊糖尿病患病率为 12.9%，而 2019 年行为风险因素监测系统（BRFSS）的估计值为 8.6%。在这个农村地区，非西班牙裔黑人（21%）和西班牙裔（15%）居民的确诊糖尿病患病率明显高于非西班牙裔白人（12%）居民。53%的无糖尿病前期或糖尿病史的受访者被评为糖尿病前期高危。最近邻居分析显示，确诊糖尿病的热点主要位于该县人口密度较高的地区。
我们向沙利文县所有居民邮寄的健康调查显示，与基于小范围电话样本的 BRFSS 模型估计值相比，糖尿病患病率更高。我们的研究结果表明，农村社区需要更好的糖尿病监测，这可能受益于专门为改善农村居民血糖控制而制定的干预措施。
