Lower Diabetes Incidence in Northwest US and Higher Incidence in South

by Anand Munsif

Posted on Friday 8th of July 2011

Dr. Munsif reported that the incidence of diabetes is higher in the South when compared to states in the Northwest. Among other states with low incidence of diabetes is Vermont.

Incidence in these states was 10 to 12 cases per 1000 when compared to 4 to 6 cases in the Northwest. Similar data was reported for obesity and physical inactivity.

Regional imbalances in incidence of diabetes have been reported. Regions of the country with higher incidence of diabetes signifies existence of environmental factors which trigger such higher numbers.

Diabetes is a major public health problem in the United States and the world.

There are 23 million people (7.9% of total population)who suffer from diabetes in North America and 194 million (5.1% of total population) in the world.

Distinction between incidence and prevalence of a disease

Incidence of a disease is defined as the occurrance of new cases of a disease over period of one year in a given population per 1,000 population. This is different from prevalence of a disease, which refers to all cases of a disease (old and new cases).

Regional imbalances in incidence of diabetes

In the United States, the states with higher incidence of diabetes (10.8 to 12.8 per 1000 population) include not only the states in the south (Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee and West Virginia), but also Texas and Arizona and Puerto Rico. States with lower incidence (5.0 to 7.6 per 1,000 population are not only in the northwest (Montana, North Dakota, South Dakota and Wisconsin) but also Colorado, Ohio, Oregon and Vermont, with Vemont with the lowest incidence of 5 cases per 1,000 population. Virginia has lower incidence of diabetes, although it is surrounded by states with much higher incidence.

Modifiable risk factors for diabetes and correlation of prevalence of obesity and physical inactivity with geography

The South also has higher incidence of the modifiable risk factors for type 2 diabetes, viz. obesity and physical inactivity. The prevalence of obesity is greatest in the south (27.3%) and least in the northwest (23.1%). The Midwest (25.5%) and Northeast are in the middle with regard to prevalence of diabetes. Therefore, the higher incidence of diabetes in the south is not surprising. Obesity prevalence exceeded 30% in three southern states: Alabama, Mississippi, and Tennessee.

The South had greater prevalence of physical inactivity (17.4%), compared with the Northeast (15.7%), Midwest (14.1%), and West (11.2%).


Diabetes statistics reveal regional imbalances. The causes of these regional imbalances (primarily higher incidence in the south) are not known. However, an inference ccan be made from statistics which reveal higher incidence of modifiable risk factors for diabetes (obesity and physical inactivity) in the same geographical area. Copyright (c) 2009 A. N. Munsif.


1. Diabetes mellitus handbook, Morristown Publishing Company, P.O. Box 672, Livingston, New Jersey 07039, 2009.
2. Centers for Disease Control (CDC),MMWR 2008; 57(43);1169-1173 (http://cdc.gov).
3. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997--2003. Am J Prev Med 2006;30:371-7 (http://www.ajpm-
4. CDC. State-specific prevalence of obesity among adults---United States, 2007. MMWR 2008;57:7658 (http://www.cdc.gov/mmwr/).
5. Knowler WC, Barrett-Conner E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention. N Engl J Med 2002;346:393-403 (http://content.nejm.org/).
6. United Nations - Department for Economic and Social Information - Population Division. World urbanization prospects: the 1994 revision. Estimates and projections of urban and rural populations and of urban agglomerations. United Nations, New York, 1995


Dr. Munsif reported that incidence of diabetes is higher in the southern states of the United States when compared to states in the Northwest. Among other states with low incidence of diabetes is Vermont. Incidence in these states was 10 to 12 cases per 1000 when compared to 4 to 6 cases in the northwest. Similar data was reported for obesity.

Category 1: Health/Diseases and Conditions/Diabetes
Category 2: Health/Medicine
Category 3: Health/Wellness

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