Race, Geography, and the Control of Diabetes and High Blood Pressure

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Mainous AG, King DE, Garr DR, et al: Race, rural residence, and control of diabetes and hypertension. Ann Fam Med 2:563-568, 2004.

What is the problem and what is known about it so far?

African Americans have a greater chance of getting type 2 diabetes and high blood pressure. Also, people who live in rural areas have less access to health care. But little is known about whether African Americans who live in rural areas are more likely to have uncontrolled diabetes or high blood pressure

Why did the researchers do this particular study?

To see if there are any differences in how often diabetes or high blood pressure are diagnosed among whites and African Americans, including those who live in rural areas compared to those who live in cities. They also wanted to see if there are differences in how much medical attention they received.

Who was studied?

More than 11,000 participants were included. Participants were found from the National Health and Nutrition Examination Survey (NHANES), a large, ongoing study run by the federal Centers for Disease Control.

How was the study done?

The NHANES study asked people to complete a detailed survey about medical conditions and characteristics such as eating habits and physical activity. Participants had a physical exam by a doctor, and had blood drawn for lab tests.

What did the researchers find?

In general, white people have better control over their diabetes and high blood pressure control than African Americans, and those who live in cities do better than those who live in rural areas.

Diabetes was found in 4.5% of urban whites, 6.5% of rural whites, 6% of urban African Americans, and 9.5% of rural African Americans.

Researchers also compared everyone’s A1C levels (a measure of long-term glucose control). High, unhealthy levels of A1C were found in 33% of urban whites, 43% of rural whites, 45% of urban African Americans, and 61% of rural African Americans.

Among those with high blood pressure, a diastolic pressure (the pressure when the heart is relaxed between beats) was in the unhealthy range in 11% of rural whites, 13% of urban whites, 20% of urban African Americans, and 23% of rural African Americans.

What were the limitations of the study?

A lot of the information used in the NHANES study was self-reported, which may not be accurate.

The researchers did not look at people who lived in suburban areas, which could lead to different results.

The study includes whites and African Americans, but did not include Hispanics or other ethnic groups.

What are the implications of the study?

People who live in rural areas may benefit from more and better health services.