Regional differences in the impact of diabetes on population health in the USA.

Journal Article (Journal Article)


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.


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.


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.


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

Full Text

Duke Authors

Cited Authors

  • Zang, E; Lynch, SM; West, J

Published Date

  • January 2021

Published In

Volume / Issue

  • 75 / 1

Start / End Page

  • 56 - 61

PubMed ID

  • 32855262

Pubmed Central ID

  • 32855262

Electronic International Standard Serial Number (EISSN)

  • 1470-2738

International Standard Serial Number (ISSN)

  • 0143-005X

Digital Object Identifier (DOI)

  • 10.1136/jech-2020-214267


  • eng