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Regional differences in the impact of diabetes on population health in the USA
  1. Emma Zang1,
  2. Scott M Lynch2,
  3. Jessica West3
  1. 1 Department of Sociology, Yale University, New Haven, Connecticut, USA
  2. 2 Department of Sociology, Duke University Population Research Institute, Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
  3. 3 Department of Sociology, Duke University, Durham, North Carolina, USA
  1. Correspondence to Emma Zang, Department of Sociology, Yale University, New Haven, CT, USA; emma.zang{at}


Background To evaluate regional disparities in the influence of diabetes on population health, we examine life expectancies at age 50 between population with diabetes and healthy population and life quality among the population with diabetes among native-born Americans by birth region and current residence.

Methods Using data on a cohort of 17 686 native-born individuals from the Health and Retirement Survey (1998–2014), we applied a Bayesian multistate life table method to estimate life expectancies at age 50 between population with diabetes and healthy population by each birth/current region combination. We further estimate the proportion of life remaining without either chronic conditions or disabilities as a quality of life measure and the probabilities that one region is worse than the other in terms of different health outcomes.

Results At age 50, persons with diabetes (PWD) were expected to live on average 5.8–10.8 years less than their healthy equivalents across regions. Diabetes had the greatest influence on life expectancy (LE) for older adults who lived in the South at the time of interviews. PWD born in the South were more likely to have developed chronic conditions or disabilities and spent greater proportions of life with these two issues compared to other regions.

Conclusion Diabetes is a significant threat to LE and healthy LE in the USA, particularly for people born or living in the South.

  • Diabetes
  • quality of life
  • geography
  • epidemiology of chronic diseases
  • health expectancy

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  • Twitter Emma Zag @DrEmmaZang and Jessica West @jswest.

  • Contributors EZ and SML designed the research. EZ performed the analyses. EZ and JW took the lead in writing the manuscript. All authors discussed the results and contributed to the final manuscript.

  • Funding EZ received support from the Research Education Core of the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342). SML received support from NIH/NIA grant R01AG040199.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.