Identifying geographic disparities in diabetes prevalence among adults and children using emergency claims data

David C. Lee, Mary Pat Gallagher, Anjali Gopalan, Marcela Osorio, Andrew J. Vinson, Stephen P. Wall, Joseph E. Ravenell, Mary Ann Sevick, Brian Elbel

Research output: Contribution to journalArticlepeer-review


Geographic surveillance can identify hotspots of disease and reveal associations between health and the environment. Our study used emergency department surveillance to investigate geographic disparities in type 1 and type 2 diabetes prevalence among adults and children. Using all-payer emergency claims data from 2009 to 2013, we identified unique New York City residents with diabetes and geocoded their location using home addresses. Geospatial analysis was performed to estimate diabetes prevalence by New York City Census tract. We also used multivariable regression to identify neighborhood-level factors associated with higher diabetes prevalence. We estimated type 1 and type 2 diabetes prevalence at 0.23% and 10.5%, respectively, among adults and 0.20% and 0.11%, respectively, among children in New York City. Pediatric type 1 diabetes was associated with higher income (P = 0.001), whereas adult type 2 diabetes was associated with lower income (P < 0.001). Areas with a higher proportion of nearby restaurants categorized as fast food had a higher prevalence of all types of diabetes (P < 0.001) except for pediatric type 2 diabetes. Type 2 diabetes among children was only higher in neighborhoods with higher proportions of African American residents (P < 0.001). Our findings identify geographic disparities in diabetes prevalence thatmay require special attention to address the specific needs of adults and children living in these areas. Our results suggest that the food environmentmay be associated with higher type 1 diabetes prevalence.However, our analysis did not find a robust associationwith the food environment and pediatric type 2 diabetes, which was predominantly focused in African American neighborhoods.

Original languageEnglish (US)
Pages (from-to)460-470
Number of pages11
JournalJournal of the Endocrine Society
Issue number5
StatePublished - May 2018


  • Clinical science and care
  • Epidemiology
  • Information technology
  • Nutrition and diet
  • Socioeconomic aspects

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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