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Popul Health Manag. 2019 Jan 28. doi: 10.1089/pop.2018.0165. [Epub ahead of print]

Community Characteristics and Regional Variations in Diabetes Prevalence in Texas Counties.

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1 School of Public Health, Texas A&M University, College Station, Texas.
2 Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas.


Diabetes has become a critical population health issue in the United States. Although researchers have focused on diabetes prevalence at the individual level, few studies address community contexts of diabetes prevalence at the county level. The objective of this study is to explore the association between community characteristics and diabetes prevalence in 254 counties in Texas. Using 3 countywide data sets in 2012, the authors measured county-level community characteristics, including social, environmental, and health behavior factors, and examined how these county-level factors are associated with diabetes prevalence. Multivariate ordinary least squares models weighted with population of county were used for estimation. Rurality, physical inactivity prevalence, and obesity prevalence were positively associated with diabetes prevalence, while the percentage of nonphysician health care professionals was negatively associated with diabetes prevalence. The findings indicate that environmental and health behaviors are significantly associated with a high prevalence of diabetes, but more nonphysician health care professionals, including nurse practitioners, may mitigate diabetes prevalence. This study highlights the significance of community factors in diabetes prevalence and provides insights for diabetes prevention programs with nonphysician health care professionals.


community characteristics; county-level context; diabetes prevalence; health disparities


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