Race, Rural Residence, and Control of Diabetes and Hypertension

Arch G. Mainous; Dana E. King; David R. Garr; William S. Pearson

doi:10.1370/afm.119

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Table 1.

Population Estimates of Demographic Characteristics and Access to Care Indicators

Characteristics and Indicators	Urban Whites (n = 106,830,224) %	Rural Whites (n = 28,330,66) %	Urban African Americans (n = 16,845,014) %	Rural African Americans (n = 2,547,044) %	PValue
Age					<.01
20–34	33.1	27.6	41.7	33.3
35–49	31.3	25.2	31.3	29.2
50–64	18.3	21.4	15.1	19.0
65+	17.3	25.8	11.8	18.5
Sex, male	48.2	47.0	44.9	43.0
Health status					<.01
Excellent	22.7	18.6	17.1	10.1
Very good	34.7	30.0	24.1	17.2
Good	30.4	32.7	37.0	42.3
Fair	9.7	14.3	17.9	22.9
Poor	2.4	4.4	3.8	7.4
Body mass index					<.01
<18.5	2.6	2.6	2.4	3.3
18.5–24.9	44.6	40.0	36.4	33.9
25.0–29.9	32.0	35.0	32.7	29.0
30.0+	20.7	22.4	28.4	33.8
Highest year of school completed >12 y	46.8	28.4	30.5	14.7
Health Insurance					<.01
Public	6.1	8.9	21.1	27.9
Private	85.4	79.1	64.0	58.8
None	8.4	12.0	14.9	13.2
Income ≥$20,000	75.4	56.7	48.2	28.9
Usual source of care, none	20.7	16.0	24.3	15.9
Hospital stays in last year					<.01
No visits	88.2	86.50	84.4	84.5
1 visit	8.4	10.2	11.4	11.4
2 or more visits	3.4	3.3	4.2	4.0
Physician visits in last year					.09
No visits	20.3	22.3	21.8	22.7
1 visit	21.6	19.4	22.9	21.6
2 or more visits	58.0	58.3	55.4	55.7
Time since physician visit ≤12 mo	82.8	80.8	82.4	81.7

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Table 2.

Diagnosis and Control of Diabetes and Hypertension

Characteristic	Urban Whites %	Rural Whites %	Urban African Americans %	Rural African Americans %	PValue
HbA_1c = glycosylated hemoglobin.
Previously diagnosed diabetes	4.5	6.5	6.0	9.5	<.01
Previously diagnosed hypertension	23.3	28.5	28.8	36.0	<.01
Previously diagnosed diabetes and elevated HbA_1c, ≥8%	42.6	32.6	45.4	60.6
Previously diagnosed hypertension and elevated systolic blood pressure, >140 mmHg	38.6	38.1	41.7	44.1
Previously diagnosed hypertension and elevated diastolic blood pressure, >90 mmHg	13.5	11.0	20.2	23.2

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Table 3.

Likelihood of Having Poor Glycemic and Blood Pressure Control Among Adults with Previously Diagnosed Diabetes and Hypertension

Adjusted Models*	Odds Ratio	95% CI
Note: elevated hemoglobin = HbA_1c ≥ 8.0%; elevated systolic blood pressure = >140 mmHg; elevated diastolic blood pressure = >90 mmHg.
CI = confidence interval; HbA_1c = glycosylated hemoglobin.
* Adjusted for age, sex, level of income, insurance coverage, and level of education.
† Adjusted for age, sex, level of income, insurance coverage, level of education, self-reported health status, length of time with disease, body mass index, usual source of care, number of times seeing physician within last year.
Adults with diabetes
Elevated HbA_1c^*
Urban whites	0.49	0.26–0.93
Rural whites	0.32	0.20–0.49
Urban African Americans	0.49	0.32–0.76
Rural African Americans	1.00	1.00–1.00
Elevated HbA_1c^†
Urban whites	0.55	0.31–0.95
Rural whites	0.33	0.21–0.52
Urban African Americans	0.53	0.34–0.82
Rural African Americans	1.00	1.00–1.00
Adults with hypertension
Elevated systolic blood pressure*
Urban whites	0.67	0.54–0.83
Rural whites	0.54	0.39–0.75
Urban African Americans	1.06	0.85–1.31
Rural African Americans	1.00	1.00–1.00
Elevated systolic blood pressure^†
Urban whites	0.68	0.54–0.85
Rural whites	0.53	0.38–0.76
Urban African Americans	1.07	0.85–1.34
Rural African Americans	1.00	1.00–1.00
Elevated diastolic blood presssure*
Urban whites	0.44	0.29–0.67
Rural whites	0.40	0.23–0.68
Urban African Americans	0.77	0.50–1.17
Rural African Americans	1.00	1.00–1.00
Elevated diastolic blood pressure^†
Urban whites	0.45	0.30–0.68
Rural whites	0.40	0.24–0.68
Urban African Americans	0.77	0.50–1.17
Rural African Americans	1.00	1.00–1.00

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The Article in Brief

Blacks living in rural areas not only have higher rates of diabetes and hypertension than urban blacks and both rural and urban whites, according to this study they also have significantly worse control of the diseases. Researchers found that rural blacks with diabetes have higher blood glucose levels, and rural blacks with hypertension have higher diastolic blood pressure than other groups with the same conditions. Efforts are needed to address the health problems of patients living in rural areas, especially those who are of lower income and are black. The authors of this study call for more people, programs, and resources to address these important health needs.