America’s rural and urban divide in diabetes deaths has tripled in the past two decades, according to a study unveiled today — amid increasing hospital closures and less access to expertise in rural areas.
Research led by Keele University in Newcastle, England, looked at more than 6.5 million diabetes-related deaths between 1999 and 2019. They found that while the rate declined in urban areas — especially among women and older adults — it rose in rural areas about the same. period of time.
Scientists behind the study blamed reduced access to health care, a lack of access to diabetes expertise and hospital closures in rural areas for the increasing deaths from diabetes.
It comes after a study published last year also warned of a growing urban-rural divide over the number of deaths from diabetes. It also found that the number of deaths from diabetes had tripled over the same period.
President Biden introduced the $35 price cap on insulin medications earlier this year to help diabetes patients, but has yet to make a concerted effort to combat the growing rate of the condition in rural areas.
The chart above shows death rates where diabetes was the underlying – or major – cause of death in urban (blue) and rural (orange) areas in America from 1999 to 2019
Researchers, who published their findings Saturday in Diabetologycollected data from the Centers for Disease Control and Prevention for the study.
Every death certificate registered in the US has an underlying – or major – cause of death listed, along with up to 20 contributing factors – or other conditions – that led to the death but were not the main cause.
The study included 1.5 million fatalities where diabetes was an underlying cause of death, and 5 million where diabetes was listed as a contributing factor.
About 80 percent were in urban areas.
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Meals should be based on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally whole grains, according to the NHS
• Eat at least 5 servings of different fruits and vegetables every day. All fresh, frozen, dried and canned fruits and vegetables count
• Basic meals on potatoes, bread, rice, pasta or other starchy carbohydrates, preferably whole grain
• 30 grams of fiber per day: This is equivalent to eating all of the following: 5 servings of fruits and vegetables, 2 whole-grain cereal biscuits, 2 thick slices of whole-wheat bread, and large baked potato with skin
• Have some dairy or dairy alternatives (such as soy drinks) and choose options with less fat and less sugar
• Eat some beans, legumes, fish, eggs, meat and other proteins (including 2 servings of fish per week, one of which is fatty)
• Choose unsaturated oils and spreads and consume in small amounts
• Drink 6-8 cups/glasses of water a day
• Adults should have less than 6 g of salt and 20 g of saturated fat for women or 30 g for men per day
Source: NHS Eatwell Guide
To compare urban and rural areas, they calculated a death rate, allowing for comparisons between areas of different population sizes.
It showed that for deaths where diabetes was the underlying cause, the gap between 1999 and 2019 grew from 2.0 to 6.8 deaths per 100,000 people — a threefold increase.
In rural areas, it rose from about 26.6 to 27.3 per 100,000, while in urban areas it shrank 20 percent from 24.6 to 20.5.
Among those where diabetes was a contributing factor, the gap also widened from 6.8 to 24.3 per 100,000 — also tripling.
In both areas, men were more likely to die from diabetes than women over the study period.
The gap was most pronounced in adults under the age of 55, they added, and adults of Indian or black background had the highest death rates.
In the study led by Dr. Ofer Kobo, a cardiologist, and others said, “Our finding of a widening gap in diabetes outcomes is consistent with previous studies.
‘[We found] these differences remained significant even after multiple adjustments for ethnicity, education, poverty and clinical characteristics.’
Explaining the gap, they added: ‘Managing diabetes and its complications requires expertise that may be difficult to access in rural communities.
‘Residents of rural provinces are less likely to receive the usual primary care from doctors. Moreover, there is a disproportionate closure of hospitals in rural areas.’
Diabetes is a condition in which the body becomes desensitized to insulin, meaning cells have trouble absorbing sugar from the bloodstream.
There are two types: type 1 diabetes, which is a genetic condition, and type 2, which is usually related to habits, including overeating.
People diagnosed with the condition should monitor their blood sugar levels and use insulin shots to control them.
However, if blood sugar becomes uncontrolled, it can lead to serious health complications and even death from causing a heart attack, stroke, kidney failure, or a coma.
The study found that in 1999 there were 54,747 deaths in urban areas where diabetes was the underlying cause, but 20 years later this had risen to 69,848.
In rural areas, the figures also rose from 13,652 to 17,799 in the same period.