Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Erin Abner, PhD

Committee Member

Thomas Tucker, PhD

Committee Member

Corrine Williams, ScD, MS



The rural, mountainous Appalachian region continuously has poorer health outcomes than the rest of the United States. This is true for many chronic diseases including diabetes: the 7th leading cause of death in the United States. This study assessed differences in the prevalence of diagnosed diabetes between older adults in rural, Appalachian counties and rural, non- Appalachian counties.


Data for the year 2013 was extracted from the Centers for Medicare and Medicaid Services (CMS) Public Use Files for Medicare beneficiaries (September 2015), which provides county level prevalence for diabetes as well as several other conditions among Medicare fee-for-service beneficiaries. Appalachian counties were defined as those considered Appalachian by the Appalachian Regional Commission. Rural and non-rural counties were defined using the 2013 Economic Research Service Rural-Urban Continuum codes (RUCCs). Differences in the prevalence of diagnosed diabetes were assessed using a negative binomial regression.


In the final model, diagnostic diabetes prevalence was slightly lower in the rural, Appalachian group when compared to non-rural reference group (PR: 0.98 [95% CI: 0.97-1.00]). While in the rural, non-Appalachian group, diagnostic prevalence was slightly higher when compared to the reference group (1.01 [95% CI: 0.99-1.02]). Although, the difference was not statistically significant for either group.


Because of earlier onset of diabetes in Appalachia, it is possible that diagnostic prevalence of diabetes begins to level off in an older adult population. Another possible explanation for no statistically significant difference in prevalence being found between these groups is that low access to care in rural, Appalachia results in more undiagnosed and untreated cases. Further studies using individual level data and looking at all age groups would be needed to better understand diabetes prevalence in rural, Appalachia.

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