Diabetes and Forgone Medical Care Due to Cost in the U.S. (2011-2015): Individual-level and Place-Based Disparities


Diabetes, particularly Type 2 diabetes, affects millions of Americans with a particular burden placed on more vulnerable populations. Underlying factors (e.g., residing in low-resource rural areas) may contribute to poor health-related outcomes for persons with diabetes. This study used 2011-2015 data from the Behavioral Risk Factor Surveillance System, to investigate trends in diabetes rates and forgone medical care among persons with diabetes in the U.S. and to identify geographic determinants (i.e., place-based) and other social determinants of health disparities. Results indicate that both the southern U.S. and rural areas faced a greater burden of diagnosed diabetes. Areas that failed to expand Medicaid through the Affordable Care Act may face a greater burden of both diabetes and forgone medical care due to cost among those with diagnosed diabetes. This study highlighted the critical role that both individual-level and place-based (i.e., geospatial factors), namely region and rurality, play in diabetes and forgone medical care. Practical applications of this study include a call for increased focus on prevention, diagnosis, and diabetes self-care education and proper maintenance of diabetes among at-risk populations.

Southwest Rural Health Research Center
Samuel Towne Jr, Jane Bolin, Alva Ferdinand, Emily Nicklett, Matthew Smith, Timothy Callaghan, Marcia Ory