Rural-urban differences in diabetes and diabetes management may be attributed to socioeconomic differences and treatment available to rural residents. Using data from 2021-2023 National Health Interview Survey (NHIS), this study will examine 1) rural-urban differences in diabetes and prediabetes incidence and prevalences, and 2) rural-urban differences in the management, treatment, and complications associated with diabetes, and co-occurring risk factors for cardiovascular disease. Using data from the 2021 and 2022 CDC WONDER, we will also report diabetes mortality differences by rurality and race/ethnicity.

The data for this project is publicly available and nationally representative. Rurality will be defined using the measure provided in the NHIS data – the National Center for Health Statistics Urban-Rural classification scheme for counties. This measure has four levels of rurality: large central metro, large fringe metro, medium and small metro, and nonmetropolitan. Incidence will be estimated from those newly diagnosed with diabetes in the year prior to the survey from age at time of survey and age at diagnosis. Incidence, prevalences, and mortality data will be reported by levels of rurality overall as well as overlapping categories of rurality and race/ethnicity. Race and ethnicity will be reported in the following four categories: Hispanic, non-Hispanic white, non-Hispanic Black, and non-Hispanic all other races. Rural-urban prevalences and mortality rates will also be reported by Census regions (Northeast, Midwest, South, West). Diabetes-related mortality data available at the county-level will be mapped to assess updated geographic clustering of diabetes deaths.