Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Jul 24:11:E125.
doi: 10.5888/pcd11.140135.

The geography of diabetes by census tract in a large sample of insured adults in King County, Washington, 2005-2006

Adam Drewnowski  1 , Colin D Rehm  2 , Anne V Moudon  3 , David Arterburn  4
Affiliations
Comparative Study

The geography of diabetes by census tract in a large sample of insured adults in King County, Washington, 2005-2006

Adam Drewnowski et al. Prev Chronic Dis. .

Abstract

Introduction: Identifying areas of high diabetes prevalence can have an impact on public health prevention and intervention programs. Local health practitioners and public health agencies lack small-area data on obesity and diabetes.

Methods: Clinical data from the Group Health Cooperative health care system were used to estimate diabetes prevalence among 59,767 adults by census tract. Area-based measures of socioeconomic status and the Modified Retail Food Environment Index were obtained at the census-tract level in King County, Washington. Spatial analyses and regression models were used to assess the relationship between census tract-level diabetes and area-based socioeconomic status and food environment variables. The mediating effect of obesity on the geographic distribution of diabetes was also examined.

Results: In this population of insured adults, diabetes was concentrated in south and southeast King County, with smoothed diabetes prevalence ranging from 6.9% to 21.2%. In spatial regression models, home value and college education were more strongly associated with diabetes than was household income. For each 50% increase in median home value, diabetes prevalence was 1.2 percentage points lower. The Modified Retail Food Environment Index was not related to diabetes at the census-tract level. The observed associations between area-based socioeconomic status and diabetes were largely mediated by obesity (home value, 58%; education, 47%).

Conclusion: The observed geographic disparities in diabetes among insured adults by census tract point to the importance of area socioeconomic status. Small-area studies can help health professionals design community-based programs for diabetes prevention and control.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Diabetes prevalence was smoothed by using an empirical Bayes tool, King County, Washington, 2005–2006. Eastern portions of census tracts in eastern King County are not shown because they are sparsely populated and consist mostly of forested land.
Figure 2
Figure 2
Local clusters of census-tract–level diabetes prevalence in King County, Washington, 2005–2006, as determined by the Getis-Ord* (Gi*) statistic (17). Eastern portions of census tracts in eastern King County are not shown because they are sparsely populated and consist mostly of forested land. In the key, “none” indicates no clustering; “high,” a cluster of census tracts that have a high prevalence of diabetes; “low,” a cluster of census tracts that have a low prevalence of diabetes.
Supplemental Figure 1
Supplemental Figure 1
Association between smoothed diabetes prevalence and the natural logarithm of median home value, King County, Washington, 2005–2006.
Supplemental Figure 2
Supplemental Figure 2
Association between smoothed diabetes prevalence and the percentage of residents with a college degree, King County, Washington, 2005–2006.
Supplemental Figure 3
Supplemental Figure 3
Association between smoothed diabetes prevalence and median household income, King County, Washington, 2005–2006.
Supplemental Figure 4
Supplemental Figure 4
Association between smoothed diabetes prevalence and smoothed obesity prevalence, King County, Washington, 2005–2006.
See this image and copyright information in PMC

References

    1. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol 2011;40(3):804–18. 10.1093/ije/dyr029 - DOI - PubMed
    1. Barker LE, Kirtland KA, Gregg EW, Geiss LS, Thompson TJ. Geographic distribution of diagnosed diabetes in the U.S.: a diabetes belt. Am J Prev Med 2011;40(4):434–9. 10.1016/j.amepre.2010.12.019 - DOI - PubMed
    1. Cadwell BL, Thompson TJ, Boyle JP, Barker LE. Bayesian small area estimates of diabetes prevalence by U.S. county, 2005. J Data Science 2010;8:173–88. - PMC - PubMed
    1. Tierney EF, Burrows NR, Barker LE, Beckles GL, Boyle JP, Cadwell BL, et al. Small area variation in diabetes prevalence in Puerto Rico. Rev Panam Salud Publica 2013;33(6):398–406. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Estimated county-level prevalence of diabetes and obesity — United States, 2007. MMWR Morb Mortal Wkly Rep 2009;58(45):1259–63. - PubMed

Publication types

MeSH terms