The Rural Landscape of Diabetes in the United States

Rural-urban differences in diabetes and diabetes management may be attributed to socioeconomic differences and treatment available to rural residents. Using data from 2021-2024 National Health Interview Survey (NHIS), this study examined 1) rural-urban differences in diabetes and prediabetes incidence and prevalence, and 2) rural-urban differences in the management, treatment, and complications associated with diabetes, and co-occurring risk factors for cardiovascular disease.

The data for this project is publicly available and nationally representative. Rurality was defined using the measure provided in the NHIS data – the National Center for Health Statistics Urban-Rural classification scheme for counties. This measure has four levels of rurality: large central metro, large fringe metro, medium and small metro, and nonmetropolitan. Incidence was estimated from those newly diagnosed with diabetes in the year prior to the survey from age at time of survey and age at diagnosis. Incidence, prevalence, and mortality data were reported by levels of rurality. Rural-urban prevalences and mortality rates were also reported by Census regions (Northeast, Midwest, South, West). Diabetes-related mortality data available at the county-level were mapped to assess updated geographic clustering of diabetes deaths.

Publications

• Geographic and Sociodemographic Patterns in Prevalence of Diagnosed Diabetes, U.S., 2021–2024
  Journal Article
  University of South Carolina Rural Health Research Center
  Date: 04/2026
  A comparison of National 2021-2024 data of diagnosed diabetes among rural and urban adults across multiple socioeconomic groups confirms the need for public health strategies tailored to both rural and urban communities, and within rural communities, across sociodemographic groups.
• Rural-Urban Trends in the Burden of Diabetes Among U.S. Adults
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 03/2026
  This brief provides an updated analysis of diabetes incidence, prevalence, and mortality across rural and urban counties. The National Health Interview Survey (2021, 2022, and 2023) provided diabetes incidence and prevalence data. CDC Wonder provided diabetes mortality data.