Although previous studies have reported higher diabetes (DM) mortality among individuals who live in rural areas, little is known about deaths due to DM, diabetic ketoacidosis (DKA) or diabetic coma by urbanization among U.S. population under age 45 years. We used National Vital Statistics System data from 1999 to 2017 filed in all 50 states and the District of Columbia obtained from CDC Wonder ( DM-related deaths were based on any listed ICD-10 codes E10-E14. DKA or diabetic coma deaths were based on any listed ICD-10 codes E10-E14 with X.1 or X.0. Urbanization was classified into 5 categories based on the 2013 National Center for Health Statistics definition. Results were reported for 1999- 2007, 2008-2017 and age standardized to the 2000 U.S. population by 10-year age groups for age 5 to 44 years. For both DM-related and DKA and diabetic coma deaths, rates for large fringe metro were lower than other areas (p < 0.001). (Table) The absolute difference in DM-related deaths increased over time in all urbanization categories (p < 0.05) except in large central metro. Rates of DKA or diabetic coma death increased significantly in medium/small and non-core areas (p < 0.05), but remained stable in large central metro. (Table) Exploring underlying causes for the disparities in deaths by urbanization may lead to improved care and fewer deaths.


S. Shaydah: None. G. Imperatore: None. C. Mercado: None. K.M. Bullard: None. S.R. Benoit: None.

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