OBJECTIVE To determine the relative hazards of acute and chronic diabetes complications among people with diabetes across the U.S. rural-urban continuum. RESEARCH DESIGN AND METHODS This retrospective cohort study used the OptumLabs Data Warehouse, a deidentified data set of U.S. commercial and Medicare Advantage beneficiaries, to follow 2,901,563 adults (age ≥18 years) with diabetes between 1 January 2012 and 31 December 2021. We compared adjusted hazard ratios (HRs) of diabetes complications in remote areas (population <2,500), small towns (population 2,500–50,000), and cities (population >50,000). RESULTS Compared with residents of cities, residents of remote areas had greater hazards of myocardial infarction (HR 1.06 [95% CI 1.02–1.10]) and revascularization (HR 1.04 [1.02–1.06]) but lower hazards of hyperglycemia (HR 0.90 [0.83–0.98]) and stroke (HR 0.91 [0.88–0.95]). Compared with cities, residents of small towns had greater hazards of hyperglycemia (HR 1.06 [1.02–1.10]), hypoglycemia (HR 1.15 [1.12–1.18]), end-stage kidney disease (HR 1.04 [1.03–1.06]), myocardial infarction (HR 1.10 [1.08–1.12]), heart failure (HR 1.05 [1.03–1.06]), amputation (HR 1.05 [1.02–1.09]), other lower-extremity complications (HR 1.02 [1.01–1.03]), and revascularization (HR 1.05 [1.04–1.06]) but a smaller hazard of stroke (HR 0.95 [0.94–0.97]). Compared with small towns, residents of remote areas had lower hazards of hyperglycemia (HR 0.85 [0.78–0.93]), hypoglycemia (HR 0.92 [0.87–0.97]), and heart failure (HR 0.94 [0.91–0.97]). Hazards of retinopathy and atrial fibrillation/flutter did not vary geographically. CONCLUSIONS Adults in small towns are disproportionately impacted by complications of diabetes. Future studies should probe for the reasons underlying these disparities.

中文翻译：

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美国城乡连续体糖尿病急性和慢性并发症的差异

目的 确定美国农村和城市连续体糖尿病患者急性和慢性糖尿病并发症的相对危险。研究设计和方法 这项回顾性队列研究使用 OptumLabs 数据仓库（美国商业和 Medicare Advantage 受益人的去识别数据集）追踪 2012 年 1 月 1 日至 2021 年 12 月 31 日期间 2,901,563 名患有糖尿病的成年人（年龄≥18 岁）。我们比较了调整后的数据偏远地区（人口<2,500）、小城镇（人口2,500-50,000）和城市（人口>50,000）糖尿病并发症的风险比（HR）。结果 与城市居民相比，偏远地区居民心肌梗死（HR 1.06 [95% CI 1.02–1.10]）和血运重建（HR 1.04 [1.02–1.06]）风险较高，但高血糖风险较低（HR 0.90 [0.83]） –0.98]）和中风（HR 0.91 [0.88–0.95]）。与城市相比，小城镇居民患高血糖（HR 1.06 [1.02–1.10]）、低血糖（HR 1.15 [1.12–1.18]）、终末期肾病（HR 1.04 [1.03–1.06]）、心肌病的风险更大梗塞（HR 1.10 [1.08–1.12]）、心力衰竭（HR 1.05 [1.03–1.06]）、截肢（HR 1.05 [1.02–1.09]）、其他下肢并发症（HR 1.02 [1.01–1.03]）和血运重建（HR 1.05 [1.04–1.06]），但卒中风险较小（HR 0.95 [0.94–0.97]）。与小城镇相比，偏远地区居民发生高血糖（HR 0.85 [0.78–0.93]）、低血糖（HR 0.92 [0.87–0.97]）和心力衰竭（HR 0.94 [0.91–0.97]）的风险较低。视网膜病变和心房颤动/扑动的危险没有地域差异。结论 小城镇的成年人受糖尿病并发症的影响尤为严重。未来的研究应该探讨这些差异背后的原因。