Trends And Patterns Of Disparities in Diabetes And Chronic Kidney Disease Mortality Among US Counties, 1980–2014

Discussion 

This study revealed large diferences among US counties in mortality rates from diabetes and CKD. The findings showed little improvement in age-standardized mortality rates from diabetes and signifcant increases in age-standardized mortality rates due to CKD between 1980 and 2014. Diabetes mortality increased substantially from 1980 to 2000 with a downward trend thereafter. On the other hand, CKD mortality increased sharply in recent decades. These findings will assist in examining the root causes of these trends and disparities among US countries. Moreover, they will provide valuable insights into developing and implementing programs and policies to reduce the burden and disparities of diabetes and CKD mortality.

This study showed that diabetes mortality has declined at the national level from 2000 to 2014 at a time when the prevalence of diabetes was increasing [2]. This is the result of a decline in the case fatality rate due to better treatment and management of diabetes. However, there are huge variations in the rate of decline by counties indicating the need for better access to medical care throughout the country [28].

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These results showed a rapid increase in CKD mortality from 1990 to 2014 in the USA. Several studies have reported little improvement in CKD prevalence in the USA from 1990 to 2015 [29]. This finding is surprising since there are known efective interventions such as ACE inhibitors to prevent CKD progression [30]. This finding has several implications. CKD is a disease that requires extensive medical care and resources such as dialysis and others [8]. Indeed, this rise will put a lot of strain on the medical system in the coming years. CKD mortality due to diabetes and hypertension increased in recent years, underscoring the need for better treatment and management of blood pressure and diabetes. Both diabetes and blood pressure diagnosis and control are not optimal in the USA. Several studies have shown that counties have large variations in diagnoses and control of diabetes and blood pressure [28, 31]. Early detection through screening of high-risk individuals is crucial to control blood pressure and diabetes and reduce diabetes and CKD burden and mortality [32]. Early diagnosis will facilitate treatment and behavioral changes and will increase survival. There is a need for more aggressive programs to control blood pressure and diabetes that include medical and preventive care approaches.

Access to and quality of medical care have a major impact on mortality from diabetes and CKD [33]. Several studies have shown that timely diagnosis of diabetes and CKD and proper treatment reduce the complications and improve the outcome [32, 34]. Unfortunately, not all US residents have equal access to quality medical care. Both diabetes and CKD require that the patient adhere to long-term management of the condition [35]. It is possible that proper management of these conditions varies by county and has led to these disparities. However, many physicians in the USA, especially in poor and rural areas where the patient load is heavy, have little or no time for patient counseling. In addition, the current health system financing does not reimburse health facilities for time spent on patient education. Several studies have shown that obesity has rapidly increased in the USA during the period of this study [36, 37]. Some studies have called obesity an epidemic as it has impacted all geographic areas and demographic groups [6]. Recent reports showed a slight improvement in physical activity, but many individuals in the USA do not meet the recommended levels of physical activity [36]. There is a need for programs to improve physical activity in the USA to reduce the burden of diabetes as well as many other conditions. Diet is a major risk factor for type 2 diabetes and for CKD [5]. For example, low intake of whole grains and the consumption of processed food and red meats are known risk factors for type 2 diabetes [9]. Also, a diet high in salt consumption is associated with increased blood pressure [38]. The 2019 Global Burden of Disease showed that poor diet is a major cause of type 2 diabetes [29]. In the USA, diet has not improved much during the study period [39]. Moreover, there is only limited information on dietary habits at the local level. The only available source for county dietary intake is 6 questions on fruits and vegetables from the behavioral risk factor surveillance system [40].

The Diabetes Prevention Program and Outcomes Study shows that type 2 diabetes is largely preventable through a healthy lifestyle [41]. The study showed that lifestyle interventions were also cost-effective. However, the long-term effects of such a program have not been well documented. It is time to invest in prevention activities in communities to improve behaviors. Perhaps, sponsoring innovations is a means to find local solutions since counties and communities need financial and technical support to solve these challenges. Diabetes and CKD are associated with poor quality of life [42]. Several studies have shown that diabetes patients have more days of poor mental and physical health [42, 43]. They are more likely to miss work and be less productive [44]. Therefore, social support initiatives for patients and their caregivers are important for improving their quality of life.
Our study showed high levels of diabetes and CKD mortality in areas in the South East, especially around the Mississippi River. Previous research has identified diferences in socioeconomic status, diferences in the prevalence of behavioral and metabolic risk factors, and diferences in access to and quality of health care as potential drivers of diferences in life expectancy among counties, with risk factors explaining the largest proportion of the diferences in life expectancy [45]. Unfortunately, areas with high diabetes and CKD mortality in our manuscript have high levels of obesity, low levels of physical activity, high levels of smoking, and poor diet. Addressing these risk factors would be the best strategy to reduce the burden of many chronic conditions. This study has several important limitations. First, the data sources underlying this analysis, i.e., deaths, population, and covariates, are each subject to error. Second, the garbage code redistribution methods used for this analysis have not been validated due to a lack of appropriate gold standard data. Third, uncertainty due to garbage code redistribution methods has not been quantified and included in the uncertainty intervals reported for this analysis. Fourth, the small area estimation moderates smooth mortality rates over space, time, and age group which may attenuate unusually low or high mortality rates, leading to an underestimation of geographic variation.

Conclusions

This study found large inequalities among counties in diabetes and CKD mortality. The findings provide insights into the root causes of this variation. Risk factors, access to medical care, and quality of medical care must improve in many parts of the country to reduce the burden of these diseases. As the US population grows and ages, and as medical costs continue to rise, a renewed focus on prevention efforts is urgently required. Abbreviations BRFSS: Behavioral risk factor surveillance systems; CKD: Chronic kidney disease; GBD: Global burden of disease; ICD: International classification of diseases; NCHS: National Center for Health Statistics; YLLs: Years of life lost.

References 

1. Murray CJL, et al. Five insights from the global burden of disease study 

2. 2019. The Lancet. 2020;396(10258):1135–59. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 

3. 2019. The Lancet. 2020;396(10258):1204–23. Wang H, et al. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global 4. Burden of Disease Study 2019. The Lancet. 2020;396(10258):1160–1203

4. Centers for Disease Control and Prevention. Behavioral risk factor surveillance system, 1990–2020. https://www.cdc.gov/brfss/. Accessed Nov 11, 2021. 

5. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9. 

6. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286(10):1195–200. 

7. Ford ES, Williamson DF, Liu S. Weight change and diabetes incidence: findings from a national cohort of US adults. Am J Epidemiol. 1997;146(3):214–22. 

8. Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016;316(24):2627–46. 

9. Afshin A, Micha R, Khatibzadeh S, et al. The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis. BMJ Open. 2015;5(5):e006385.

10. Rehm CD, Peñalvo JL, Afshin A, Mozafarian D. Dietary intake among us adults, 1999–2012. JAMA. 2016;315(23):2542–53.