Diabetes-related deaths have dropped over the last couple of decades in the United States — but this overall trend has not been seen in rural areas, according to a new study published in the journal Diabetologia.
Even as rates of diabetes have gone up in the United States and other countries, there have been a number of encouraging trends in recent years — for example, deaths from type 1 diabetes declined between 2000 and 2016, a drop that researchers attribute to advances in treatment and cardiovascular disease prevention. Undiagnosed diabetes has also become less of a problem in the United States, meaning that more people are getting the treatment they need to prevent long-term diabetes complications. At the same time, rates of diabetes complications like visual impairment have gone down, reflecting the ongoing advances in diabetes detection and treatment.
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But as the latest study shows, not all geographic areas have benefited from this recent progress. Researchers looked at trends in diabetes deaths in both urban and rural areas between 1999 and 2019, a time span that does not take into account the toll of COVID-19 on people with diabetes. Using a database on causes of death from the Centers for Disease Control and Prevention (CDC), they estimated trends in the age-adjusted mortality rate from diabetes in both urban and rural counties.
Diabetes death rates higher in rural than urban areas
The researchers found that in all age groups and racial or ethnic categories, the age-adjusted death rate from diabetes was higher in rural than urban counties. Over the study period, the overall rate of death from diabetes as the underlying (main) cause decreased in urban areas by 16.7%, while the rate of death with diabetes as a contributing cause decreased by 13.5%. At the same time, the rate of death from diabetes as the underlying cause in rural areas increased by 2.6%, and the rate of death with diabetes as a contributing cause increased by 8.9%.
When the results were broken down by racial and ethnic categories, only American Indians saw a decrease in diabetes-related deaths in both urban and rural areas — with an overall decrease of 19.8% for death from diabetes as the underlying cause and 40.5% for death with diabetes as a contributing cause.
For people who identified as white and lived in an urban area, the rate of death from diabetes as the underlying cause decreased by 10.7%, and the rate of death with diabetes as a contributing cause decreased by 15.4%. But for white people in rural areas, the the rate of death from diabetes as the underlying cause increased by 2.4%, and the rate of death with diabetes as a contributing cause increased by 10.6%.
For people who identified as Black and lived in an urban area, the rate of death from diabetes as the underlying cause decreased by 26.6%, and the rate of death with diabetes as a contributing cause decreased by 28.3%. For Black people in rural areas, on the other hand, the the rate of death from diabetes as the underlying cause decreased by 6.5%, while the rate of death with diabetes as a contributing cause increased by 1.8%.
The researchers concluded that the overall decrease in diabetes deaths in the United States has been concentrated in urban areas, with rural areas seeing worsening trends. “A synchronized effort is needed to improve cardiovascular health […] and healthcare access in rural areas and to decrease diabetes-related mortality,” they wrote.
Want to learn more about health care in rural areas? Read “Rural Areas Often Get Left Behind in Diabetes Care,” “Many Rural Americans Live in Pharmacy ‘Desert’ With Limited Vaccine Access” and “Telemedicine for Rural Residents.”