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Diabetes Data Reflect Health, Income and Socio-Economic Divides

Living a healthy lifestyle is not easy in the U.S.; keeping fit can be tough in the land of supersizes and never-ending pasta bowls. But the health problems aren’t the same everywhere, and in a paper released Tuesday, the Centers for Disease Control and Prevention identified an area they call “the diabetes belt” with high incidences of the disease.

The belt paints a red blob across the Southern U.S. and could be interpreted as a regional problem. There is some truth to that, of course.

But look at that same map through our 12 Patchwork Nation county types. You can see some of the smaller differences we have tracked and noted on this site.

There are clearly strong ties between high diabetes rates and larger African-American populations — a long-known problem — but it’s not that cut and dry. The problem isn’t only about poor black communities in the South. There are also larger socio-economic and cultural issues at play.

And when you consider pre-existing conditions and health insurance policies, the diabetes belt also raises questions about the health-care reform debate.

Diabetes Hotspots

The contours of the CDC’s diabetes map, based on 2008 data, are hard to ignore, and when you lay them against the Patchwork Nation map, there are some clear correlations.

Community Type Percent of Adults With Diabetes Number of Counties
Monied ‘Burbs 8.7 286
Minority Central 12.7 364
Evangelical Epicenters 11 468
Tractor Country 9.1 311
Campus and Careers 8.7 71
Immigration Nation 8.9 204
Industrial Metropolis 9.3 41
Boom Towns 8.8 384
Service Worker Centers 10.1 663
Empty Nests 9 250
Military Bastions 10.2 55
Mormon Outposts 8.1 44
Nationwide 9.9 3141

Two of our 12 community types are heavily represented in diabetes belt: the Minority Central counties with large African-American populations and the socially conservative Evangelical Epicenters. They have the highest percentage of adults with diabetes: 12.7 percent and 11 percent, respectively.

Mainly set in the area many know as the Bible Belt, they are two of the most regionally focused community types. But income may be almost as significant a shared trait, as both have the lowest median household incomes in Patchwork Nation: $30,000 for Minority Central and $31,500 for the Epicenters.

Look carefully at those maps and you’ll notice a few holes in the diabetes belt — lower rates around Shelby County, Ala., (home of Birmingham) and Cherokee County, Ga., (metropolitan Atlanta).

These places are exceptions to the region and not just where diabetes is concerned. There are islands of relative wealth in what is largely a sea of rural poverty. The point? Income matters a lot in the diabetes problem.

That divide can also be seen when one looks at the small-town Service Worker Center counties. Those 663 counties have hardly any presence at all in the diabetes belt. They’re scattered across the Northeast, Midwest and West Coast, yet they have relatively high rates of diabetes. On average 10.1 percent of the adult population has diabetes in those counties.

The Service Worker Centers are not as poor as Minority Central or the Evangelical Epicenters, but their $35,000 median household income is well below the national average.

The opposite is true with the diabetes statistics as well. The wealthier and better-educated county types such as the Monied ‘Burbs, Industrial Metropolis, Boom Towns and Campus and Careers counties all have diabetes rates below the national average.

As we have noted in more detailed analyses, these communities are home to roughly 90 percent of Whole Foods organic grocery stores. That may be driven in large part by income, but it is also driven by desire. Not everyone can pay for organic arugula, but not everyone wants it either.

Diabetes and Health Care

Add all those numbers and trends up and there looks to be serious implications in the next few years as the health-care reform law begins to take effect.

Counties hardest hit by diabetes such as Minority Central and Service Worker Centers not only have lower incomes, but they also tend to have higher unemployment and poverty rates, according to Patchwork Nation analysis. That means many of the people suffering from diabetes probably don’t have insurance, either because their jobs don’t provide coverage or they don’t have jobs.

But some of that may be set to change.

Under the current health-care reform law, insurance companies will no longer be able to deny coverage for the disease starting in 2014. On top of that, the employer mandates mean those who do have jobs would at least have the chance to obtain coverage.

The American Diabetes Association said diabetes currently costs the U.S. health care system some $116 billion annually. “People with diagnosed diabetes, on average, have medical expenditures that are approximately 2.3 times higher than the expenditures would be in the absence of diabetes,” the group writes on its website.

It doesn’t take a math whiz to see the potential for sharply rising costs.

That’s one of many reasons why those fighting the disease think the battle against it is one of the keys to getting health-care spending under control.

But changing diets and habits is no simple task, and these numbers seem to make the fight even harder.

People who live in wealthier areas not only have more money and, in most cases, better health care, they also seem to have the track to a healthier lifestyle overall, at least where diabetes is concerned. And leveling that playing field is not easy.

Dante Chinni is the director of Patchwork Nation.
Editor’s Note: Some typographical errors were fixed after the initial posting of this story. This a corrected version.

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