A Keele-led study has found there is a widening gap in death rates between diabetes patients from rural and urban areas in the USA, with those from rural areas more adversely affected.

Led by Keele's Professor Mamas Mamas, the researchers analysed 20 years' worth of data from the US Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database, which recorded the cause of death of every US resident who died in the period 1999-2019.

The team found that the age adjusted mortality rate (AAMR) of diabetes patients was higher in rural areas across all age, sex, and ethnicity groups and over the 20-year period, with no statistically significant change in the AAMR of diabetes as the underlying or contributing cause of death in rural areas.

In contrast, urban areas saw a significant decrease in the AAMR of diabetes as the underlying (−17%) and contributing (−14%) cause of death over the same time period. As a result, the urban-rural diabetes-related mortality gap has tripled in the USA, rising from 2.0 to 6.8 deaths per 100,000 population for diabetes as the underlying cause, and from 6.8 to 24.3 deaths per 100,000 population for the disease as a contributing factor, with the main impact being felt by male patients and those under-55 years old.

The authors highlight that successful management of diabetes and the control or prevention of associated complications requires medical expertise that may be unavailable or difficult for rural populations to access. Patients in these communities are also less likely to have their primary care delivered by physicians, and they have been further impacted by the disproportionate closure of rural hospitals.

Lead author Professor Mamas said: "The widening of mortality in patients with diabetes between rural and urban areas is a cause for concern and highlights the challenges in delivering healthcare in deprived rural areas. Whilst this data is derived from the United States, it may have significant implications for healthcare policy and structure of services in the UK and warrants further investigation."