Introduction: Evaluating diabetes prevalence and prediabetes risk in rural settings can be difficult due to sparse population coverage and limited data.

Objective: To evaluate diabetes burden and prediabetes risk in a rural county with documented poor health outcomes.

Methods: In 2021, we 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. We included questions on demographics, medical history, and the American Diabetes Association’s Prediabetes Risk Test in our survey. A score of 5 points or higher on this test is considered high risk for having prediabetes. To help mitigate non-response bias, statistical raking was performed using age, sex, race/ethnicity, and health insurance strata. We analyzed diabetes prevalence and prediabetes risk by demographic characteristics. We also used geospatial analysis within the county to assess for clustering of diagnosed diabetes cases and elevated prediabetes risk scores.

Results: Of 4,725 survey responses analyzed, the adjusted diabetes prevalence in our sample was 14% compared to the 20BRFSS estimate of 8.6% for Sullivan County. In this rural area, diabetes prevalence was notably higher among non-Hispanic Black (23%) and Hispanic (16%) residents compared to non-Hispanic White (13%) residents. Prediabetes risk scores were elevated among 41% of respondents without a history of diabetes. Nearest neighbor analyses revealed that hotspots of diagnosed diabetes and high prediabetes risk scores were primarily located in more urban areas of this rural county.

Conclusion: Our mailed health survey to all residents in Sullivan county demonstrated higher diabetes prevalence compared to modelled BRFSS estimates that are based on a small telephone sample. Our results suggest the need for better diabetes surveillance in rural communities, which may benefit from interventions specifically tailored for improving glycemic control among rural residents.


D.C.Lee: None. N.A.Mcgraw: None. L.Thorpe: None. C.Quintero arias: None. M.Rony: None. R.Patel: None. E.Jensen: None. R.Petcu: None. D.M.Imas: None. B.Elbel: None. R.Anthopolos: None.


National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)

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