Onset of type 1 diabetes mellitus in rural areas of the USA

J Epidemiol Community Health. 2019 Dec;73(12):1136-1138. doi: 10.1136/jech-2019-212693. Epub 2019 Sep 28.


Background: In the USA, the epidemiologic features of type 1 diabetes are not well-defined across all 50 states. However, the advent of large nationwide insurance databases enables the investigation of where type 1 diabetes cases occur throughout the country.

Methods: An integrated database from a large nationwide health insurer in the USA (Clinformatics Data Mart Database) was used, from 2001 to 2017. The database contained longitudinal information on approximately 77 million people.

Results: The incidence of type 1 diabetes was greatest in areas of low population density across the 50 states. Individuals in the lowest population density areas had rates that were 2.28 times (95% CI 2.08 to 2.50) that of persons living in high-density areas. This association was consistent across various measures of rural status (p<0.001 for population density; p<0.001 for per cent rural as defined by the US Census Bureau; p=0.026 for farmland). The association between rural areas and the incidence of type 1 diabetes was evident across all four general regions of the USA.

Conclusions: The predilection of type 1 diabetes in rural areas provides clues to potential factors associated with the onset of this autoimmune disease.

Keywords: diabetes; epidemiology; epidemiology of diabetes; geography; neighborhood/place.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Diabetes Mellitus, Type 1 / epidemiology*
  • Humans
  • Incidence
  • Population Density
  • Residence Characteristics
  • Rural Population / statistics & numerical data*
  • United States / epidemiology