The state of diabetes care provided to Medicare beneficiaries living in rural America.

CONTEXT: Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level.
PURPOSE: To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities.
METHODS: Medicare beneficiaries with diabetes aged 18-75 were identified from Part A and Part B claims data from 1999 to 2001. A composite of 3 diabetes care indicators was assessed (annual hemoglobin A1c test, biennial lipid profile, and biennial eye examination).
FINDINGS: Over 77% had a hemoglobin A1c test, 74% a lipid profile, and 69% an eye examination. Patterns of care were considerably different across the urban-rural continuum at the state, Census division, and regional levels. States in the northern and eastern portions of the country had higher indicator rates for rural than for urban residents. States in the South had much lower rates for rural residents than their urban counterparts. Despite these within-state differences, across-state comparisons found that several states tended to have low indicator rates in every level of the urban-rural continuum. A common feature of these states was the relatively high concentration of nonwhite beneficiaries. For example, southern states had much higher concentrations of nonwhite beneficiaries relative to other areas in the country and demonstrated low rates in every level of the urban-rural continuum.
CONCLUSIONS: Urban-rural quality of care differences may be a function not just of geography but also of the presence of a large nonwhite population.