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IN THE RED: Higher-resolution county health data from a nationwide survey should help local agencies better combat chronic conditions, such as diabetes. (On map: Deep red shows counties where at least 11.2 percent of the population has been diagnosed with diabetes.)
Image: CDC/National Diabetes Surveillance System
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More than 18 million people in the U.S. have been diagnosed with diabetes, which costs an estimated $174 billion annually. Typically, local public health agencies carry out the initiatives to manage and prevent this chronic disease, but because prevalence figures are generally given on national and state levels, local workers cannot gain the traction—and funding—to rein in rates in their areas.
A new study drills down to the county level, revealing wide disparities within states and striking national patterns. "We're extremely excited about the county level," says Lawrence Barker, associate director for science at the U.S. Centers for Disease Control and Prevention (CDC) Division of Diabetes Translation.
Many of the counties with the highest rates of diagnosed diabetes—higher than 11.2 percent of the population compared with the national average of 8.5 percent—are concentrated in 15 states and form an area the study's authors have labeled the "diabetes belt" (after the so-called "stroke belt" that described U.S. Southeast in the 1960s).
"We've known for many years that there was a lot of diabetes in the Southeast," Barker says. But the new analysis, based on data from the self-reported national phone survey called the Behavioral Risk Factor Surveillance System (BRFSS), confirmed that the disease has a distinctive geographical distribution. The map and findings will be published in the April 2011 issue of the American Journal of Preventive Medicine.
The pattern of disease distribution is not a simple slice—nor does it follow the stroke belt. The diabetes belt touches states as far north as Ohio and Pennsylvania and as far west as Texas. But overall averages for many of these outlying states would not reveal the plights of their few high-prevalence counties.
State numbers have long been misleading, says Ali Mokdad, who works at the University of Washington School of Medicine's Institute for Health Metrics and Evaluation (IHME) in Seattle and was not involved in the new study." A state number masks a lot of the variation in the state," he says. Similar county-level work that he has done showed that although states such as Colorado can have low levels of diabetes overall (7.1 percent), the average can be misleading because super-low counties (such as Pitkin County's 4.5 percent) can cover up those with sky-high rates (such as Crowley County's 14.1 percent).
With new local data, however, the 644 counties in the diabetes belt match up to known risk factors for the disease, including: a high obesity rate (32.9 percent versus 26.1 percent nationally); sedentary lifestyles (30.6 percent versus 24.8 percent); lower education levels (24.1 percent with college degrees versus 34.3 percent) and more non-Hispanic blacks (23.8 percent versus 8.6 percent).
Even people who live in diabetes belt counties and whose demographics would not otherwise raise any red flags for being high risk for diabetes (for example, young, white and not obese) are more likely to have been diagnosed with the condition, Barker says.
The good news, Barker and his colleagues report, is that about 30 percent of the extra risk faced by people in diabetes belt counties is tied to lifestyle choices that can be changed. "If people led more active lifestyles, then the new cases of diabetes would be smaller," he said. Modifying people's risky behavior should bring the diabetes numbers closer to national averages—"eventually," Barker says.
Barker, who is based in Georgia, one of the states that has many counties in the diabetes belt, suggests that one of the reasons for the striking distribution might have to do with the area's economic history. "These are regions and areas that were once heavily agricultural," he says. But as the economy has shifted away from farming—especially the more local, labor-intensive agriculture of the early and mid-20th century—to more sedentary jobs, people might not have adjusted their diets to compensate for smaller daily calorie requirements and are "continuing to eat the same way they used to," he speculates.
The 15 states that have counties in the diabetes belt are Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia. Belt counties, however, are unevenly distributed among those states on the list, ranging from a few in Ohio and Texas to the majority of Alabama's counties—and every one in Mississippi.
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23 Comments
Add CommentSigh, this is not rocket science. One metric to compare is sales of MacDonald's and other fast food outlets in the "Diabetes Belt."
Reply | Report Abuse | Link to thisIf people are living in poverty, they are eating for next to nothing at fast food joints like MacDonalds -- and pumping nothing but greasy lard into their bodies. Although that might provide a short fix if trying to stave off starvation in a disaster (i.e. you survive a plane crash and must hike out of the Rockies on foot), long-term ingestion of the toxic smorgasbord of fats and chemicals dished out by fast food corporations is like going on the program "Get Diabetes in Less Than a Year!"
The United States and other developing nations have turned into a fast food nightmare guaranteed to bankrupt their healthcare systems in the coming decades.
This map is remarkably similar to the "food dessert" map that appeared at http://www.slate.com/id/2287061/slideshow/2287079/device/simpleHtml/fs/0//entry/2287071/.
Reply | Report Abuse | Link to thisEyesWideOpen's comment reinforces this point of the lack of accessible quality food.
With the exception of Florida this map also represents all of the very hot and muggy states where going outside to lead and active lifestyle is miserable.
Reply | Report Abuse | Link to thisI hardly think "hot and muggy" has anything to do with it. The "cold and miserable" states would be the same but they are not.
Reply | Report Abuse | Link to thisThe southern diet is based on "If it ain't fried - it ain't food". This catchy slogan has put generations of poor southerners in perilous health since the civil war.
Reply | Report Abuse | Link to thisOne will have to overcome ignorance, poverty, and southern traditions in order to alter the unhealthy habits of the people who live in the diabetes belt.
Food choice is an existential issue for the US middle class. Democracy as implemented with lobbies and a public in denial is sinking the nation in a self reinforcing whirlpool of entrenched food, drug, health care provider and tax interests.
Reply | Report Abuse | Link to thisAgg lobbies -> Food lobbies -> bad, cheap food -> disease -> drugs / healthcare -> benefits / taxes -> lobbies -> bankrupt / uncompetitive USA
Please read "The china study" and "Food Revolution" and chat them up with everyone you can. Sad.
Maybe. BUT it is also true that raising one's body temperature is metabolically expensive (more than cooling), not to mention shoveling snow. And of course fast food is a problem but so are the traditional regional foods. Lack of infrastructure makes driving necessary and, at least in rural areas, walking - almost impossible. If you do want to walk, not only is it true that the heat (for most of the year) is unbearable but also treacherous (ticks, snakes, tall grasses) AND besides the mailbox, you really don't have anywhere to go. Poverty and poor education are also BIG issues (THE real problem?). Food is cheap and the constant feeling of insecurity about the next paycheck, the next meal, etc., can cause one to 'put a little in the bank' when there is plenty. Most people desire a certain level of physical and psychological comfort. Unfortunately, down here too often that means sitting in the AC and watching Fox "news" while eating a box of ding-dongs.
Reply | Report Abuse | Link to thisYes, but despite it's geography, most of Florida is NOT a Southern state, culturally speaking.
Reply | Report Abuse | Link to thisYes, but despite it's geography, most of Florida is NOT a Southern state, culturally speaking.
Reply | Report Abuse | Link to thisIt is often forgotten that late onset Type 2 diabetes can also have a strong inheritance factor. A healthy lifestyle and good BMI do not give immunity in such cases. A control regime is then more constrained - with only minor adjustments being possible via lifestyle options.
Reply | Report Abuse | Link to thisThe description of the affected communities in this study suggests that genetic inheritance should not be discounted.
A recent study also links poor nutrition during pregnancy to genetic changes for the offspring developing Type 2. The genetic effect it has can also be passed down through more than one generation.
This map is the negative print of the map of corporate America. No more comments!
Reply | Report Abuse | Link to thisLike most pandemic diseases, diabetes could be controlled by attention to trace element nutrition - in this case zinc deficiency. See www.scienceuncoiled.co.uk, for the background science. Zinc interacts with the hormones insulin and glucagon to regulate cellular uptake of glucose, also with vitamin C. Associated conditions treatable with zinc are neonatal jaundice, anorexia nervosa, infection by colds and flu and the various skin, eye and reproductive side-effects of diabetes.
Reply | Report Abuse | Link to thisZinc supplements are cheap and safe at the recommended dosage, commonly marketed in association with vitamin C. Along with a sensible balanced diet and exercise, this small change could make a big difference.
How about a 1850 map of the slave population and a breakdown of the racial percentages of diabetes cases.
Reply | Report Abuse | Link to thisMight help understand the problem.
Clearly the FDA needs to establish a public health crisis case against "junk foods" including many "fast foods," banning combinations of foods not fit for safe human consumption, thereby forcing corporations (such as MacDonald's, Kentucky Fied Chicken and other name brands I find most offensive) to reform or get shutdown.
Reply | Report Abuse | Link to thisTo avoid the complete collapse of our healthcare system that will cost countless TRILLIONS, the FDA needs to clean house in a multi-trillion dollar "food" industry whose elite few wealthy executives get rich off the destruction of human health. This toxic industry needs to get slapped down (or rather punched down with a clenched fist) by the government -- similarly to what the tobacco industry had coming and abundantly got -- to avoid a mass health collapse as threatening as the unleashing of dirty bombs in major cities and urban areas nationwide.
A fat, sugar and salt tax might help. Making it an offense to cause your children to become obese may also help. I would also recommend subsidizing nutritious foods for low income families, like food stamps but that can only be used on fresh foods rather than processed. School breakfasts are also helpful and ensure that at risk children are given the food they need to function properly at school. This also means that schools should provide nutritious meals rather than the crap they serve. Ultimately this will never pass because greedy individuals will complain that taking care of the nation's children gets in the way of them stuffing their wallets.
Reply | Report Abuse | Link to thisIf you took the map of sweet tea consumption plus regular soft drink consumption and overlayed it on the diabetes map, you'd have a pretty close match. The answers to this are obvious and the problem is largely self-induced. The cost is an outrage.
Reply | Report Abuse | Link to thisLack of accessible quality food?...I don't think so. There are some very nice supermarkets with quality produce sections, excellent farmer's markets and lots of family vegetable farms. The problem has more to do with adding sugar to everything, in my opinion.
Reply | Report Abuse | Link to thisFats are not the problem...carbs (sugar) is the problem and our governmental pro-sugar lobbyists are hard at work confusing the issue. Almost everything has sugar in it...especially milk.
Reply | Report Abuse | Link to thisNo one is forcing mom and dad to take their kiddos or give them the money to eat at McDonalds. How about some healthier foods (fruits and vegetables and ground meat) prepared at home.
Proper food and fitness are a lifestyle choice...a choice many people have made on their own. Laziness is rampant in both areas. Stop blaming others for your personal frailties.
How many of these "poor" kids have a cell phone, cable TV, food provided by food stamps (other taxpayers) and/or W.I.C. cards or other government programs? Answer: a veritable plethora.
@rtaylortitle, "How many of these "poor" kids have a cell phone..." you forgot to mention driving their Porsches to private school or taking their private jets to the Bahamas for March break. I do agree that it is a matter of choice. Unfortunately the children are either unable or incapable of making the proper choices themselves. That is why society as a whole needs to take steps to incentivize proper nutrition.
Reply | Report Abuse | Link to thisI am from the diabetes belt (foothills of the Blue Ridge) and poverty is often used as a scapegoat for so many issues, but I feel it is more simple in this case. My grandparents were dirt poor, but their diet would be the envy of many a foodie. Grass fed beef, free range chicks, fresh veggies.... They worked very hard each and everyday for that food and enjoyed the labor. They both lived in to their 90's and my grandfather was 6 months shy of 100. The majority of the people in this area have become lazy. Nothing is cheaper than 1 tomato seed and get a bushel of tomatoes and there is plenty of land to grow it. The greatest generation saved us from the Germans, but not from ourselves. Post war prosperity not poverty has made folks lazy and fat.
Reply | Report Abuse | Link to this"How many of these "poor" kids have a cell phone, cable TV, food provided by food stamps (other taxpayers) and/or W.I.C. cards or other government programs?"
Reply | Report Abuse | Link to thisWhere is my cable tv and cell phone? I am on food stamps and I have lost weight; maybe by being near a big grocery store and choosing fresh food? Although, when I only buy fresh food I have no food stamps left by the 15th. Maybe if I ate more beans I would not run out?
My instant thoughts were the same, just by looking at the map.
Reply | Report Abuse | Link to thisIt's not just what we cook, but what we buy.
I'd also like to point out 1979. The year both Coke and Pepsi went to high fructose corn syrup. Oh, I can hear the corn ag guys screaming now.
Corn syrup has a major responsibility in this epidemic.
Maybe callous, but healthcare should be abolished. The weak and sick go to the wrecker (of course humanely helped out). We're too many anyway. If a "being" would have been above us on the feeding chain it certainly would have exterminated us long ago, like we try to do with the rats, competing for resources. We should invest in development of nuclear fusion and thus liberating us from that scourge of a chronical lack of expensive energy. Of course the energy companies, presidents, investors and other interested mafias lobby furiously against that.
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