1418-P: Prevalence of Self-Reported Diagnosed Diabetes among U.S. Adults According to Metropolitan Residence and Region, United States 2019–2022

Background: Previous research suggests that rural/urban disparities in diabetes mortality, hospitalization, and incidence rates may manifest differently across US regions. However, no studies have examined disparities in diabetes prevalence by metropolitan residence and region.

Methods: Using data from the 2019-2022 National Health Interview Survey (NHIS), diabetes status, socioeconomic characteristics, and weight status were compared among adults within each Census region (Northeast, Midwest, South, West) according to county metropolitan status of residence (large central metro, large fringe metro, small/medium metro, and non-metro) using Chi-squared tests. Logistic regression models were fit to assess the association of metropolitan residence and diabetes prevalence within each region.

Results: Diabetes prevalence ranged from 7.0% in large fringe metro counties in the Northeast to 14.8% in non-metro counties in the South. Compared to adults from large central metro counties, those from small/medium metro counties had significantly higher odds of diabetes in the Midwest (age, sex, and race/ethnicity adjusted odds ratio [OR]=1.24; 95% confidence interval [CI]: 1.06-1.45) and South (OR=1.15; 95% CI: 1.02-1.30). Non-metro residence was also associated with diabetes in the South (OR=1.62 vs large central metro; 95% CI: 1.43-1.84). After further adjustment for socioeconomic and body weight status, small/medium metro associations with diabetes became attenuated and nonsignificant but non-metro residence in the South remained significantly associated with diabetes (OR=1.22; 95% CI: 1.07-1.39).

Conclusion: The association between metropolitan residence and diabetes prevalence differs across regions of the United States. These findings can help to guide efforts in areas where diabetes prevention and care resources may be better directed.