Investigation of geographic disparities of pre-diabetes and diabetes in Florida

Jennifer Lord,Shamarial Roberson,Agricola Odoi

doi:10.1186/s12889-020-09311-2

Jennifer Lord, Shamarial Roberson + Show 1 more

Open Access

https://doi.org/10.1186/s12889-020-09311-2

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Abstract

BackgroundDiabetes is a leading cause of death and disability in the United States, and its precursor, pre-diabetes, is estimated to occur in one-third of American adults. Understanding the geographic disparities in the distribution of these conditions and identifying high-prevalence areas is critical to guiding control and prevention programs. Therefore, the objective of this study was to investigate clusters of pre-diabetes and diabetes risk in Florida and identify significant predictors of the conditions.MethodsData from the 2013 Behavioral Risk Factor Surveillance System were obtained from the Florida Department of Health. Spatial scan statistics were used to identify and locate significant high-prevalence local clusters. The county prevalence proportions of pre-diabetes and diabetes and the identified significant clusters were displayed in maps. Logistic regression was used to identify significant predictors of the two conditions for individuals living within and outside high-prevalence clusters.ResultsThe study included a total of 34,186 respondents. The overall prevalence of pre-diabetes and diabetes were 8.2 and 11.5%, respectively. Three significant (p < 0.05) local, high-prevalence spatial clusters were detected for pre-diabetes, while five were detected for diabetes. The counties within the high-prevalence clusters had prevalence ratios ranging from 1.29 to 1.85. There were differences in the predictors of the conditions based on whether respondents lived within or outside high-prevalence clusters. Predictors of both pre-diabetes and diabetes regardless of region or place of residence were obesity/overweight, hypertension, and hypercholesterolemia. Income and physical activity level were significant predictors of diabetes but not pre-diabetes. Arthritis, sex, and marital status were significant predictors of diabetes only among residents of high-prevalence clusters, while educational attainment and smoking were significant predictors of diabetes only among residents of non-cluster counties.ConclusionsGeographic disparities of pre-diabetes and diabetes exist in Florida. Information from this study is useful for guiding resource allocation and targeting of intervention programs focusing on identified modifiable predictors of pre-diabetes and diabetes so as to reduce health disparities and improve the health of all Floridians.

Highlights

Diabetes is a leading cause of death and disability in the United States, and its precursor, prediabetes, is estimated to occur in one-third of American adults
This study investigated county-level geographic disparities and predictors of pre-diabetes and diabetes prevalence reported in the 2013 Florida Behavioral Risk Factor Surveillance System (BRFSS) data
Spatial patterns and clusters The results of this study indicate that spatial patterns of high prevalence of pre-diabetes and diabetes exist at the county level in Florida

Summary

Introduction

Diabetes is a leading cause of death and disability in the United States, and its precursor, prediabetes, is estimated to occur in one-third of American adults. Diabetes-related mortality is considered the seventh leading cause of death in the United States [11]. A recent study suggests that the contribution of diabetes to national mortality is severely underestimated, and approaches 12% among adults in the United States; this would move its rank to the third leading cause of death, following heart disease and malignant neoplasms [12, 13]. In the United States, diabetes and related complications are estimated to result in direct medical costs totaling $237 billion, and $90 billion of indirect costs due to reduced productivity from causes including disability, absenteeism, and early mortality [14]

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