The American "stroke belt" has contributed to the study of stroke. However, U.S. geographic
patterns of diabetes have not been as specifically characterized.
This study identifies a geographically coherent region of the U.S. where the prevalence
of diagnosed diabetes is especially high, called the "diabetes belt."
In 2010, data from the 2007 and 2008 Behavioral Risk Factor Surveillance System were
combined with county-level diagnosed diabetes prevalence estimates. Counties in close
proximity with an estimated prevalence of diagnosed diabetes ≥11.0% were considered
to define the diabetes belt. Prevalence of risk factors in the diabetes belt was compared
to that in the rest of the U.S. The fraction of the excess risk associated with living
in the diabetes belt associated with selected risk factors, both modifiable (sedentary
lifestyle, obesity) and nonmodifiable (age, gender, race/ethnicity, education), was
A diabetes belt consisting of 644 counties in 15 mostly southern states was identified.
People in the diabetes belt were more likely to be non-Hispanic African-American,
lead a sedentary lifestyle, and be obese than in the rest of the U.S. Thirty percent
of the excess risk was associated with modifiable risk factors, and 37% with nonmodifiable
Nearly one third of the difference in diabetes prevalence between the diabetes belt
and the rest of the U.S. is associated with sedentary lifestyle and obesity. Culturally
appropriate interventions aimed at decreasing obesity and sedentary lifestyle in counties
within the diabetes belt should be considered.
Published by Elsevier Inc.