Chronic Disease Prevalence in the US: Sociodemographic and Geographic Variations by Zip Code Tabulation Area

Abstract

Introduction: We examined the geographic distribution and sociodemographic and economic characteristics of chronic disease prevalence in the US. Understanding disease prevalence and its impact on communities is crucial for effective public health interventions.

Methods: Data came from the American Community Survey, the American Hospital Association Survey, and the Centers for Disease Control and Prevention's PLACES. We used quartile thresholds for 10 chronic diseases to assess chronic disease prevalence by Zip Code Tabulation Areas (ZCTAs). ZCTAs were scored from 0 to 20 based on their chronic disease prevalence quartile. Three prevalence categories were established: least prevalent (score ≤6), moderately prevalent (score 7-13), and highest prevalence (score ≥14). Community characteristics were compared across categories and spatial analyses to identify clusters of ZCTAs with high disease prevalence.

Results: Our study showed a high prevalence of chronic disease in the southeastern region of the US. Populations in ZCTAs with the highest prevalence showed significantly greater socioeconomic disadvantages (ie, lower household income, lower home value, lower educational attainment, and higher uninsured rates) and barriers to health care access (lower percentage of car ownership and longer travel distances to hospital-based intensive care units, emergency departments, federally qualified health centers, and pharmacies) compared with ZCTAs with the lowest prevalence.

Conclusion: Socioeconomic disparities and health care access should be addressed in communities with high chronic disease prevalence. Carefully directed resource allocation and interventions are necessary to reduce the effects of chronic disease on these communities. Policy makers and clinicians should prioritize efforts to reduce chronic disease prevalence and improve the overall health and well-being of affected communities throughout the US.

Figure 1

Categories of variables included, based on Healthy People 2030 Social Determinants of Health framework (22), in study of sociodemographic and geographic variations of chronic disease prevalence in the US by Zip Code Tabulation Area.

Figure 2

Choropleth map of the US showing the geographic distribution of chronic disease prevalence scores by quartile across Zip Code Tabulation Areas (ZCTAs). Chronic disease prevalence scores ranged from 0 to 20 with a score of 0 meaning the ZCTA was in the 25^th percentile and a score of 20 meaning the ZCTA was in the 75^th percentile of prevalence for each chronic disease examined.

Figure 3

Hot Spot analysis of chronic disease prevalence scores throughout the US calculated in ArcGIS Pro (Esri) showing significant spatial clusters of high chronic disease prevalence scores (red clusters = hot spots) and low chronic disease prevalence scores (blue clusters = cold spots).