Urbanicity and Disparities in Type 2 Diabetes—Statewide Prevalence Using an Electronic Health Record Consortium, 2020–2023

Introduction and Objective: US rural-urban disparities in type 2 diabetes (T2D) prevalence are incompletely described, with limited epidemiologic cohorts for evaluation. Our objective was to leverage electronic health record (EHR) data to evaluate disparities in T2D prevalence. Methods: Minnesota EHR Consortium includes data on 90% of Minnesota residents, from 2020-2023. For each year, T2D prevalence was based on ≥1 diagnosis code within the previous 5 years. Urbanicity was based on RUCA codes (Figure). We used logistic regression to model prevalence, and report OR (95% CI) per 1-year change. Results: T2D prevalence was 8.44% in 2020, 8.43% in 2021, 8.59% in 2022, and 8.80% in 2023. After adjusting for age, sex, and race/ethnicity, T2D prevalence increased in metro (1.007 [1.005-1.009]; P<.001), was unchanged in micro (1.005 [1.000-1.011]; P=.054) and small town (1.000 [0.994-1.005]; P=.88), and decreased in rural (0.994 [0.990-0.998]; P=.002) areas. Similarly, T2D prevalence in females differed with urbanicity; however, in males, there was no change in any urbanicity level. In all urbanicity levels, T2D prevalence was highest in Hispanic and Native American or Alaska Native adults. Conclusion: T2D prevalence differed by urbanicity, with disparities by sex, race and ethnicity. EHRs can provide a robust framework to identify disparities and tailor T2D interventions. Disclosure: S.B. Dugani: None. Y. Yu: None. L. Vaughan: None. J. Killian: None. C. Benziger: Consultant; Novartis Pharmaceuticals Corporation. Research Support; Amgen Inc, Novartis Pharmaceuticals Corporation. T. Winkelman: None. K.L. Margolis: None. K. Bergmann: None. J. Desai: None. T. DeFor: None. P.J. O'Connor: None. P. Drawz: None. I. Essien: None. M.A. Franco: None. A. Bryan: None. A.M. Chamberlain: Research Support; Exact Sciences. Funding: This project was funded by the Minnesota Department of Health through an Innovations Project grant. SBD was supported by NIH/NIMHD (K23 MD016230).