Rural-urban disparities in the prevalence of diabetes and coronary heart disease

Public Health. 2012 Oct;126(10):813-20. doi: 10.1016/j.puhe.2012.05.029. Epub 2012 Aug 24.


Objectives: To examine the rural-urban differences in the prevalence of diabetes and coronary heart disease, and the extent to which they are explained by the presence of established risk factors including poverty.

Study design: Cross-sectional study of more than 214,000 respondents using data from the US Centers for Disease Control and Prevention's (CDC's) 2008 Behavioral Risk Factor Surveillance System.

Methods: Logistic regression models were utilized; prevalence odds ratios with corresponding confidence intervals and P-values are provided.

Results: The crude prevalence rates of diabetes and coronary heart disease were 8.6% (P = 0.001) and 38.8% (P < 0.001) higher among respondents living in rural areas compared with urban areas, respectively. The higher prevalence in rural areas of many of the common risk factors for these conditions, including poverty (P < 0.001), obesity (P < 0.001) and tobacco use (P < 0.001), may contribute to these findings. After controlling for these and other risk factors, the prevalence of diabetes was lower among respondents living in rural areas [prevalence odds ratio (POR) = 0.94, P = 0.032], but the prevalence of coronary heart disease was higher (POR = 1.09, P = 0.011).

Conclusions: The higher prevalence of diabetes and coronary heart disease in rural populations in the USA presents a formidable public health challenge. It exacerbates many of the pre-existing rural health disparities, including a lack of access to financial resources and primary care providers.

MeSH terms

  • Adolescent
  • Adult
  • Coronary Disease / epidemiology*
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology*
  • Female
  • Health Status Disparities*
  • Humans
  • Male
  • Middle Aged
  • Poverty
  • Prevalence
  • Risk Factors
  • Rural Health / statistics & numerical data*
  • United States / epidemiology
  • Urban Health / statistics & numerical data*
  • Young Adult