Differences in receipt of diabetes care between residents of metropolitan and non-metropolitan areas.

Abstract

This study aimed to determine whether rural residence was associated with fewer diabetes-related healthcare visits than urban residence. We analyzed 2019-2021 Behavioral Risk Factor Surveillance System data from seven US jurisdictions that consistently administered an optional diabetes module. We included adults with a self-reported diabetes diagnosis and used weighted analyses and multivariable Poisson regression to compare the annual number of diabetes-related visits between rural and urban residents, adjusting for demographic, socioeconomic, and clinical variables. Based on a sample of 12,931 respondents, we estimated that 24% lived in rural areas. The weighted mean number of diabetes-related visits over the past year was lower for rural compared to urban residents (2.8 vs 3.0, p = 0.036). In adjusted analysis, rural residence remained associated with fewer diabetes-related visits (incidence rate ratio: 0.92; 95% CI: 0.86, 0.98; p = 0.015), corresponding to -0.24 visits per year (95% CI: -0.43, -0.05). Rural residence was associated with lower use of diabetes-related health care, even after controlling for other factors, though these data cannot establish whether the difference reflects unmet need. Whether approaches such as telehealth expansion, reimbursement reform, or provider recruitment can narrow this difference warrants evaluation in future studies.