Understanding what leads people to develop diabetes and how this disease affects people who have it is a crucial matter for public health researchers. Diabetes is associated with several health problems such as damage to nerves and kidneys and carries a high mortality rate, leading to 1.2 million deaths since 1999. With more than 29 million Americans living with diabetes and another 86 million at risk of becoming diabetic, understanding diabetes and its consequences becomes increasingly urgent.
In a policy brief for the Southwest Rural Health Research Center at the Texas A&M School of Public Health, Dr. Timothy Callaghan, assistant professor in the department of health policy and management, explored 17-years’ worth of data on diabetes-related mortality in the U.S. to clarify differences among different racial and ethnic groups and between urban and rural populations. School of Public Health faculty who assisted with this research were Dr. Jane Bolin, center director; Dr. Alva O. Ferdinand, deputy director of the center; and Dr. Samuel Towne, research assistant professor, and Ms. Marvellous Akinlotan, a doctoral student in health services research, both at Texas A&M.
The researchers used data from 1999-2015 from the National Center for Health Statistics at the Centers for Disease Control and Prevention, which contains information on mortality including cause of death at the state and local level. They broke these data down into six rurality categories ranging from large city cores to sparsely populated rural areas.
Their analysis found relatively high diabetes-related mortality rates across the U.S., however, these rates increased in line with increasing rurality. For example, Dr. Callaghan noted that, “rural noncore areas had 12.4 more deaths per 100,000 people than large central metros with more than a million residents.” This is consistent with other research showing that rural Americans are far more likely to have diabetes and to experience more adverse effects from the condition. Dr. Callaghan and colleagues then dug further into the data to determine how race and ethnicity affected the relationship between rurality and diabetes mortality.
Research has repeatedly shown racial disparities in many areas, so the researchers examined possible associations between race and diabetes-related mortality. They found that White Americans had slightly lower diabetes-related mortality rates compared to the sample of all Americans but also found that White diabetes-mortality did increase in rural areas like it did for the population as a whole. For Black Americans, the relationship between rurality and diabetes mortality remains, but mortality rates for Black Americans are significantly higher, with the lowest Black mortality rate being similar to the highest mortality rate for White Americans. For Hispanic Americans, diabetes-related mortality rates show a vastly different outcome than other racial groups and the nation. The trend toward higher mortality rates in rural areas remains; however, rates of diabetes mortality are significantly lower, with Hispanic Americans in the most rural categories having a slightly lower rate than White Americans and the overall population in the most urban category.
[Photo: Dr. Timothy Callaghan]
With a clearer picture of how rurality and race affect diabetes-mortality, researchers and practitioners can better target future research and efforts to reduce diabetes-related mortality rates. The differences in mortality rates among these groups highlight the need to include such characteristics in further diabetes mortality studies. These findings shed light on unequal rates of diabetes-related deaths, but further study will be needed to better understand the factors contributing to these differences.
“With a more complete view of mortality, researchers and policy makers will be in a better position to develop effective implementations aimed at reducing diabetes-related mortality and helping millions of Americans live longer and healthier lives,” Dr. Callaghan said.