The Rural Landscape of Diabetes in the United States

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.

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. 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.

Publications

• Rural-Urban Trends in the Burden of Diabetes Among U.S. Adults
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 03/2026
  This brief provides an updated analysis of diabetes incidence, prevalence, and mortality across rural and urban counties. The National Health Interview Survey (2021, 2022, and 2023) provided diabetes incidence and prevalence data. CDC Wonder provided diabetes mortality data.