First Advisor

Carlos Crespo

Date of Award

Spring 2021

Document Type


Degree Name

Bachelor of Science (B.S.) in Public Health Studies: Pre-clinical Health Science and University Honors


Health Studies




Diabetes -- Mortality -- United States, Mortality -- Social aspects -- United States, Geography




Given the recent research into the social determinants affecting health outcomes, the goal of this thesis is to examine whether a non-urban setting, among other social determinants of health, increases the risk of mortality among the United States diabetic population. We examined the relationship of urban and non-urban diabetes rates among those aged 40-74 years using a national sample of diabetic and nondiabetic Americans. The data was pulled from the Third National Health and Nutrition Examination Survey (NHANES III) which was conducted from 1988 to 1994. After excluding pregnant women, those who did not complete a fasting AM glucose, and those with missing information on variables for our analysis, a total of 3,219 American subjects (1,635 women and 1,584 men) were studied. Our results show no significant association between urban living and dying with diabetes. However, we found a significant interaction between urban living and insurance status in predicting diabetes mortality among persons with diabetes. Further research should investigate the influence of having health insurance in urban and rural settings. Therefore, expanding research on the social determinants of health currently impacting diabetes mortality rates has the potential to influence the work being done by healthcare professionals to address access within rural communities.


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