Rural/Urban Variations in Diabetes Self-Care and Quality of Care in a National Sample of US Adults With Diabetes

Abstract

The purpose of this study was to examine differences in diabetes self-care and provider-based quality-of-care indicators between rural and urban dwellers in a nationally representative sample of adults with diabetes. Data were analyzed on 52,817 individuals with type 2 diabetes from the 2007 Behavioral Risk Factor Surveillance Survey. Rural and urban residence was based on metropolitan statistical area. Self-care behaviors (nutrition, physical activity, self-monitoring) and quality-of-care indicators (clinical visits, glycemic control, preventive measures) were self-reported. Logistic regression analyses were done using STATA 10 to assess the independent effect of rural/urban residence on self-care and each quality measure and to account for the complex survey design. Rural residents comprised 21% of the sample and were less likely to receive diabetes education (57% vs 51%, P < .001). The final adjusted model showed that foot self-checks (odds ratio, 1.42; 95% confidence interval, 1.27-1.59) and blood glucose testing at least once daily (odds ratio, 1.14; 95% confidence interval, 1.02-1.26) were significantly higher among rural individuals. Provider-based quality of care was not significantly different by rural/urban residence. Contrary to what has been reported, there were no significant differences in diabetes quality of care between rural and urban dwellers. In addition, rural dwellers appeared to have better self-care behaviors than urban dwellers. Further research is needed to clarify the reasons for these findings.