People with diabetes who live in rural areas more likely to develop complications of the disease, UM School of Medicine study finds

March 18, 2024
They have a significantly higher risk of end-stage kidney disease, heart failure, and heart attacks likely due to a lack of access to medical care.

It has been well established that people who live in rural areas in the U.S. are more likely to have diabetes and experience barriers to managing their condition compared to those who live in the suburbs and cities. Now University of Maryland School of Medicine researchers have measured the devastating toll of this health disparity.

Those who live in small towns experience a significantly higher risk of eight complications related to diabetes – including heart attacks and kidney disease – failure compared to those who live in well populated suburbs and cities, according to a new study published in the journal Diabetes Care.

The study analyzed health insurance data from nearly 3 million adults with diabetes across the U.S. over a 10-year period through 2021. They found that those living in small towns (population size of 2,500 to 50,000 people) were 10 percent more likely to experience a heart attack, 5 percent more likely to heart failure, and about 4 percent more likely to have end-stage kidney disease compared to those living in larger towns and cities.

“Those who live in rural areas have a greater risk of experiencing 8 out of the 11 complications that we measured compared with those living in cities,” said study corresponding author Rozalina McCoy, MD, Associate Professor of Medicine at UMSOM and Director of the Precision Medicine and Population Health Program at the University of Maryland Institute for Health Computing. “They were 15 percent more likely to have dangerously low blood sugar levels, which clearly indicates that their diabetes is not being managed properly.”

About 14 percent of those in the study lived in small towns, compared to 83 percent who lived in cities. An additional 3 percent lived in remote areas of fewer than 2,500 people living within a defined geographic area in their county.

The study found that people living in remote areas had lower risks of being diagnosed with some diabetes complications. They were 15 percent less likely to have dangerously high blood sugar levels and were 6 percent less likely to experience heart failure compared to those living in small towns.

But that may not mean they are actually having fewer complications: Since the study team relied on insurance information to identify diabetes complications, if people were not able to access medical care, that complication would not be captured.

University of Maryland School of Medicine release on Newswise