Prevalence of Cardiometabolic Disease in Iowa: A County-Level Analysis of Ethnic Disparities and Screening Gaps.

Cardiometabolic conditions - including diabetes, hypertension, and hyperlipidemia - are leading contributors to morbidity, mortality, and health disparities across the United States. In Iowa, the burden of these diseases varies substantially by county, with notable geographic and racial/ethnic inequities. This ecological study analyzed data from all 99 Iowa counties to assess the prevalence of cardiometabolic diseases, evaluate demographic correlations, and identify underserved regions we term "cardiometabolic screening deserts."  We defined screening deserts as counties that lacked at least two of the following preventive services: blood pressure (BP) screening, HbA1c testing, and lipid panel access; had high poverty or uninsured rates (>15%); and were designated Health Professional Shortage Areas (HPSAs). County-level data on disease prevalence, screening availability, race/ethnicity, poverty, and provider access were obtained from state and federal datasets and analyzed descriptively. Nineteen counties (19.2%) met all criteria to be classified as screening deserts. As shown in Centers for Disease Control and Prevention (CDC) national surveillance data, disease prevalence varied widely: diabetes (6.1%-10.9%), hypertension (28.1%-39.0%), and hyperlipidemia (25.2%-39.9%). Screening availability was limited - HbA1c testing was present in only 24 counties, and lipid testing in just 18. Counties with higher proportions of Black, Hispanic, or Native American residents disproportionately lacked screening access and had higher disease burdens.  Our findings emphasize the critical need to align preventive care infrastructure with disease burden. This analysis provides a county-level framework to guide targeted interventions and improve equity in chronic disease prevention across Iowa.