Regional differences in the impact of diabetes on population health in the USA

Abstract

BackgroundTo evaluate regional disparities in the influence of diabetes on population health, we examine life expectancies at age 50 between population with diabetes and healthy population and life quality among the population with diabetes among native-born Americans by birth region and current residence.MethodsUsing data on a cohort of 17 686 native-born individuals from the Health and Retirement Survey (1998–2014), we applied a Bayesian multistate life table method to estimate life expectancies at age 50 between population with diabetes and healthy population by each birth/current region combination. We further estimate the proportion of life remaining without either chronic conditions or disabilities as a quality of life measure and the probabilities that one region is worse than the other in terms of different health outcomes.ResultsAt age 50, persons with diabetes (PWD) were expected to live on average 5.8–10.8 years less than their healthy equivalents across regions. Diabetes had the greatest influence on life expectancy (LE) for older adults who lived in the South at the time of interviews. PWD born in the South were more likely to have developed chronic conditions or disabilities and spent greater proportions of life with these two issues compared to other regions.ConclusionDiabetes is a significant threat to LE and healthy LE in the USA, particularly for people born or living in the South.

U.S. Regional Differences in Physical Distancing: Evaluating Racial and Socioeconomic Divides During the COVID-19 Pandemic

“…These differences may be due to regional variation in factors that influence COVID-19 risks, including various individual (e.g., age, pre-existing health conditions), household (e.g., poverty, household size), and community (e.g., presence of group quarters such as correctional facilities or nursing homes) factors (10). This is consistent with a long line of research on regional variation in health and mortality (11)(12)(13)(14)(15)(16). Despite apparent regional differences in COVID-19 outcomes, there has been little focus on how physical distancing behavior varies by region, which is an important omission because physical distancing trends are predictive of later COVID-19 outcomes (3).…”

“…For a few months (July-October), the Midwest replaced the South with the lowest physical distancing rates. Over the entire time period, our study shows that the Southern disadvantage in health and mortality (13,16) (and, for a few months, a Midwestern disadvantage ( 51)) extends to physical distancing behaviors. As such, services, interventions, social safety nets, and public expenditures may be particularly necessary to help people living in the South survive the pandemic.…”

“…Decades of research has documented regional variation in health outcomes, life expectancy, and mortality (11)(12)(13)(14)(15)(16). Recent research indicates that regional variation has remained a crucial part of understanding health-related patterns in the U.S. during the COVID-19 pandemic.…”

“…There are many reasons to believe that physical distancing may be structurally constrained by region. For example, compared to other regions, the South had a higher prevalence of poor health and pre - existing chronic conditions (16, 17), which might have increased medical facility visitation and limited physical distancing ability. Moreover, the prevalence of physical activities was particularly low in the South (17), and places with more health-protective behaviors prior to the pandemic (e.g., greater physical activity) exhibited a greater reduction in movement outside of the home (18).…”

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012–2016

“…The West, which is home to the larg est and lon geststand ing Asian com mu ni ties in the United States, exhibited the shortest life expec tancy among the four cen sus regions. Even Asians in the South-gen er ally described in the lit er a ture as the region hav ing some of the worst health out comes in the United States (Murray et al 2006;Zang et al 2021)-had a life expec tancy advan tage over those in the West. Moreover, the dis ad van tage observed in the West may be explained by pos i tive selec tion effects asso ci ated with immi gra tion.…”