1400-P: Rural/Urban Residence and Race/Ethnicity Differences in All-Cause Mortality Trends among Medicare Beneficiaries with Diabetes, 2001-2016

Abstract

To examine rural/urban and racial/ethnic differences in all-cause mortality from 2001-2016 among older U.S. adults with diabetes, we used Medicare claims data linked to the National Death Index. We identified beneficiaries aged ≥67y who were enrolled in fee-for-service (FFS) plans with diabetes. Rural/urban residence was based on the 2016 Medicare core-based statistical area classification. Race/ethnicity was classified as: non-Hispanic white (NHW), non-Hispanic black (NHB), Asian/Pacific Islander (API), and Hispanic (HISP). Rates were age-/sex-standardized to the 2001 FFS population. From 2001 to 2016, there were absolute declines in mortality in all rural/urban and racial/ethnic subgroups (all p<0.001; Figure). By 2016, mortality rates were higher among rural residents (vs. urban) for all racial/ethnic groups (rate ratios: NHW [1.07 (1.06-1.08)]; NHB [1.05 (1.03-1.08)]; API [1.20 (1.09-1.32)], HISP [1.09 (1.05-1.13)]). Reductions in mortality were relatively consistent among rural HISP and API residents (p-trend<0.05); while rates plateaued after 2007 for NHW and after 2011 for NHB rural residents. Among urban residents, reductions in mortality slowed (NHB [2010]; API [2007]) or stalled (NHW [2009]; HISP [2010]) at varying times. Future research may be helpful in addressing mortality disparities in this diverse, aging population. Disclosure K.M. Bullard: None. L.J. Andes: None. S. Saydah: None. D.B. Rolka: None. C. Mercado: None. G. Imperatore: None. S.R. Benoit: None.