The Effect of Depression and Rurality on Diabetes Control

ACS, American Community Survey.

↵* Depression and ischemic vascular disease were reported by the primary care practice to MN Community Measurement (MNCM). MNCM suggested the use of the Major Depression or Dysthymia (DEP-01) Value Set and Ischemic Vascular Disease Value Set, but stated that “Any documentation of a new or existing diagnosis of depression [IV.D] during the measurement period [for IV.D: or year prior] is accepted.”

↵† Rurality was determined by mapping patient ZIP code to Rural-Urban Commuting Areas, and summarizing to the WWAMI Rural Health Research Center’s Categorization B. (https://depts.washington.edu/uwruca/index.php).

↵‡ Small medical groups were defined as 2 to 11 primary care sites; large medical groups were defined as 12 or more primary care sites.

↵§ Coefficients represent the impact of a one percentage-point increase in the ACS-based statistic (e.g., 50% to 51%). Educational distribution was represented by percentage of adults with a high school degree but no 4-year college degree, and percentage with a 4-year college degree. We omitted the percentage without a high school degree to avoid collinearity in the estimation. A U-shaped impact of educational distribution in the patient’s neighborhood was evident, with neighborhoods more heavily weighted toward the high-school-only category showing poorer glycemic control.