Urban and Rural Disparities in the Availability of Diabetes Prevention Programs in US Hospitals

Abstract Purpose Type 2 diabetes is a global pandemic, with 1 in 6 people expected to be diagnosed by 2050. The Diabetes Prevention Program (DPP) is an evidence-based program that has been shown to reduce A1c and bolster health outcomes in people with type 2 diabetes and prediabetes, but implementation has been varied, with lower uptake in rural communities. The study assessed whether there are geographic disparities between rural and urban communities in hospital-supported DPPs in the US. Methods We assessed DPPs in 3,204 general medical hospitals. Data on hospital and county characteristics came from the American Hospital Association (AHA) Annual Survey, the Area Health Resource File, and County Health Rankings. We assessed geographic differences between hospitals with and without DPPs using t-tests and chi-square tests. Rurality was determined based on the 2013 Rural-Urban Continuum Codes (RUCC). We then conducted a multivariable analysis to assess the relationship between geographic location and the presence of a DPP, independent of hospital, county, and population characteristics. Findings In the unadjusted model, hospitals located in counties with lower population density had significantly lower odds of offering DPP (OR = .93, 95% CI: .0.91, 0.96). After controlling for organizational and community characteristics, population density was no longer a significant predictor of DPP. Larger hospitals had higher odds of offering DPP (OR = 1.002, 95% CI: 1.001, 1.002) as did both nonprofit (OR = 3.25, 95% CI: 2.46, 4.30) and public hospitals (OR = 3.10, 95% CI: 2.24, 4.30) as compared to their for-profit counterparts. Hospitals in the South (OR = .65, 95% CI: .53, .79) and Western (OR = .77, 95% CI: .62, .95) regions of the United States had lower odds of offering diabetes prevention programs in comparison to hospitals located in the Midwest. Conclusions DPP implementation is less common in rural and underserved areas. These programs are also less common in smaller hospitals. The interaction between resources and hospital location is helpful for understanding barriers to program implementation.