The gap between rural and urban deaths from diabetes TRIPLED from 1999 to 2019

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America's rural-urban divide in diabetes deaths has tripled over the last two decades, a study revealed today — amid mounting hospital closures and less access to expertise in rural areas.

Research led by Keele University in Newcastle, England, looked at more than 6.5million diabetes-related deaths between 1999 and 2019. They found that while the rate dropped in urban areas — particularly among women and older adults — it rose in rural places over the same time period.

Scientists behind the study blamed reduced access to healthcare, a lack of access to diabetes expertise and hospital closures in rural areas for the mounting fatalities from diabetes. 

It comes after a study published last year also warned of a growing urban-rural divide over diabetes fatalities. It found that the rate of deaths involving diabetes had tripled over the same time period. 

President Biden brought in the $35 price cap for insulin medication earlier this year to help diabetes patients, but has yet to make a concerted effort to fight the growing rates of the condition in rural areas. 

The above graph shows fatality rates where diabetes was the underlying — or main — cause of death in urban (blue) and rural (orange) areas in America from 1999 to 2019

Researchers, who published their findings Saturday in Diabetologia, gathered data from the Centers for Disease Control and Prevention for the study.

Every death certificate recorded in the U.S. has an underlying — or main — 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 1.5million fatalities where diabetes was an underlying cause of death, and 5million where it was listed as a contributing factor.

Around 80 percent were in urban areas.


Meals should be based on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain, according to the NHS

• Eat at least 5 portions of a variety of fruit and vegetables every day. All fresh, frozen, dried and canned fruit and vegetables count

• Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain

• 30 grams of fiber a day: This is the same as eating all of the following: 5 portions of fruit and vegetables, 2 whole-wheat cereal biscuits, 2 thick slices of wholemeal bread and large baked potato with the skin on

• Have some dairy or dairy alternatives (such as soya drinks) choosing lower fat and lower sugar options

• Eat some beans, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily)

• Choose unsaturated oils and spreads and consume in small amounts

• Drink 6-8 cups/glasses of water a day

• Adults should have less than 6g of salt and 20g of saturated fat for women or 30g for men a day

Source: NHS Eatwell Guide  

To compare urban and rural areas they calculated a fatality rate, allowing for comparisons between areas with different population sizes.

It showed that for deaths where diabetes was the underlying cause the gap grew from 2.0 to 6.8 deaths per 100,000 people from 1999 to 2019 — tripling.

In rural areas it rose from about 26.6 to 27.3 per 100,000, while in urban areas it shrunk by 20 percent from 24.6 to 20.5.

Among those where diabetes was a contributing factor, the gap also rose from 6.8 to 24.3 per 100,000 — also tripling.

In both areas, men were more likely to die from diabetes than women throughout the study period. 

The gap was most pronounced among adults under 55 years old, they added, and adults from Indian or Black backgrounds had the highest mortality rates. 

The study, led by Dr Ofer Kobo, a cardiologist, and others, reads: 'Our finding of an increasing gap in diabetes outcomes is in agreement with previous studies.

'[We found] these differences remained significant even after multiple adjustments for ethnicity, education, poverty levels and clinical characteristics.'

Explaining the gap, they added: 'The management of diabetes and its complications requires expertise that may be difficult to access in rural communities. 

'Residents of rural counties are less likely to have usual primary care provided by physicians. Furthermore, there has been a disproportionate closure of hospitals in rural areas.'

Diabetes is a condition where the body becomes desensitized to insulin, meaning cells struggle to absorb sugar from the blood stream.

There are two types: Type 1 diabetes, which is a genetic condition, and type 2, which tends to be linked to habits including over-eating.

People diagnosed with the condition need to monitor their blood sugar levels, and use insulin shots to keep them under control.

Should blood sugar levels become uncontrolled, however, it can lead to serious health complications and even death through triggering a heart attack, stroke, kidney failure or a coma.

The study found that there were 54,747 deaths in urban areas where diabetes was the underlying cause in 1999, but 20 years later this had risen to 69,848. 

In rural areas the figures also rose from 13,652 to 17,799 over the same period.


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