Prevalence of Self-Reported Diagnosed Diabetes Among Adults, by County Metropolitan Status and Region, United States, 2019-2022

Introduction Previous research suggests that rural-urban disparities in diabetes mortality, hospitalization, and incidence rates may manifest differently across US regions. However, no studies have examined disparities in diabetes prevalence by metropolitan residence and region. Methods We used data from the 2019-2022 National Health Interview Survey to compare diabetes status, socioeconomic characteristics, and weight status among adults in each census region (Northeast, Midwest, South, West) according to county metropolitan status of residence (large central metro, large fringe metro, small/medium metro, and nonmetro). We used chi 2 2 tests and logistic regression models to assess the association of metropolitan residence with diabetes prevalence in each region. Results Diabetes prevalence ranged from 7.0% in large fringe metro counties in the Northeast to 14.8% in nonmetro counties in the South. Compared with adults from large central metro counties, those from small/medium metro counties had significantly higher odds of diabetes in the Midwest (age-, sex-, and race and ethnicity-adjusted odds ratio [OR] = 1.24; 95% CI, 1.06-1.45) and South (OR = 1.15; 95% CI, 1.02-1.30). Nonmetro residence was also associated with diabetes in the South (OR = 1.62 vs large central metro; 95% CI, 1.43-1.84). After further adjustment for socioeconomic and body weight status, small/medium metro associations with diabetes became nonsignificant, but nonmetro residence in the South remained significantly associated with diabetes (OR = 1.22; 95% CI, 1.07-1.39). Conclusion The association of metropolitan residence with diabetes prevalence differs across US regions. These findings can help to guide efforts in areas where diabetes prevention and care resources may be better directed.