Diabetes prevalence is associated with different community factors in the diabetes belt versus the rest of the United States

Abstract

Objective This study investigated differences in community characteristics associated with diabetes prevalence between the Diabetes Belt and the rest of the contiguous U.S. Methods We used county-level adult diabetes prevalence estimates (i.e., percent of people [≥20 years] with diagnosed diabetes, 2009) from the Centers for Disease Control and Prevention, in addition to data from the U.S. Census Bureau, U.S. Department of Agriculture, and U.S. Department of Health and Human Services, to carry out a spatial regime analysis to identify county-level factors correlated with diabetes prevalence in the Diabetes Belt versus the remainder of the U.S. Results Counties outside of the Diabetes Belt demonstrated stronger positive associations between diabetes prevalence and persistent poverty and greater percentages of unemployed labor forces. For counties in the Diabetes Belt, diabetes prevalence showed a stronger positive association with natural amenities (e.g., temperate climate and topographic features) and a stronger negative association with fitness/recreation facility density. Conclusions Community-level correlates of diabetes prevalence differed between the Diabetes Belt and elsewhere in the U.S. Economic hardship was shown to be more relevant outside the Diabetes Belt, while recreational context effects were more pronounced among counties within the region. Prevention and treatment targets are geographically unique and public health efforts should acknowledge these differences in crafting policy.

Built environmental characteristics and diabetes: a systematic review and meta-analysis

“…Four studies did not observe an association between density of facilities and T2DM risk/prevalence [ 46 , 48 , 49 , 61 ]. In two other studies, the higher availability of neighbourhood resources for physical activity was associated with lower T2DM risk [ 47 , 63 ].…”

“…Twenty studies investigated characteristics of the food environment [ 46 – 48 , 51 – 55 , 60 , 61 , 63 , 69 – 77 ] (Fig. 1 , Table 2 and Additional file 2 ).…”

“…A second study observed an unadjusted correlation between a greater distance to markets and lower fasting glucose levels [ 53 ]. Five studies did not observe a significant association between availability of supermarkets/grocery stores and T2DM prevalence [ 60 , 61 , 63 , 69 , 71 , 75 ]. In a meta-analysis of three studies [ 48 , 60 , 61 ], a higher density of grocery stores was not associated with T2DM risk/prevalence (1.01; 95% CI, 0.98–1.05; I 2 = 0%).…”

The Diet and Diabetes: A Focus on the Challenges and Opportunities within the Stroke Belt Dietary Pattern

“…It has been suggested that living in the Stroke Belt during childhood may confer an additional risk for stroke, even after relocating out of the Stroke Belt [10]. Within the Stroke Belt is the "diabetes belt", characterized by a greater prevalence of diagnosed diabetes particularly among African Americans demonstrating modifiable risk factors such as obesity (as a result of a primarily sedentary lifestyle), as well as community -level characteristics, persistent poverty, low socioeconomic status (SES), unemployment and inadequate fitness and recreational facilities [11]. Characteristics of the Stroke Belt that may contribute to increased risk for diabetes are illustrated in Figure 1.…”

Obesity, Cardiovascular Disease and Sleep Disorders: Insights into the Rising Epidemic

“…[8] Pathophysiology and prevention of CVD is also very complex as there are multiple risk factors besides obesity that could increase the risk. These risk factors include but are not limited to, smoking, alcohol and drug abuse along with HTN, DM2 and/or hyperlipidemia, which are all modifiable [9]. …”