Format

Send to

Choose Destination
J Epidemiol Community Health. 2019 Sep 28. pii: jech-2019-212693. doi: 10.1136/jech-2019-212693. [Epub ahead of print]

Onset of type 1 diabetes mellitus in rural areas of the USA.

Author information

1
Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA maryroge@umich.edu.

Abstract

BACKGROUND:

In the USA, the epidemiologic features of type 1 diabetes are not well-defined across all 50 states. However, the advent of large nationwide insurance databases enables the investigation of where type 1 diabetes cases occur throughout the country.

METHODS:

An integrated database from a large nationwide health insurer in the USA (Clinformatics Data Mart Database) was used, from 2001 to 2017. The database contained longitudinal information on approximately 77 million people.

RESULTS:

The incidence of type 1 diabetes was greatest in areas of low population density across the 50 states. Individuals in the lowest population density areas had rates that were 2.28 times (95% CI 2.08 to 2.50) that of persons living in high-density areas. This association was consistent across various measures of rural status (p<0.001 for population density; p<0.001 for per cent rural as defined by the US Census Bureau; p=0.026 for farmland). The association between rural areas and the incidence of type 1 diabetes was evident across all four general regions of the USA.

CONCLUSIONS:

The predilection of type 1 diabetes in rural areas provides clues to potential factors associated with the onset of this autoimmune disease.

KEYWORDS:

diabetes; epidemiology; epidemiology of diabetes; geography; neighborhood/place

PMID:
31563896
DOI:
10.1136/jech-2019-212693

Conflict of interest statement

Competing interests: None declared.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center