Diabetes Belt has lower efficiency in providing diabetes preventive care than surrounding counties

Hyojung Kang, Min Woong Sohn, Soyoun Kim, Siyao Zhang, Rajesh Balkrishnan, Roger Anderson, Anthony McCall, Timothy McMurry, Jennifer Mason Lobo

Research output: Contribution to journalArticlepeer-review


Annual preventive care is essential for diabetes patients to reduce the risk of complications including hypoglycemic events and blindness. Our aim was to examine the relative efficiency of Diabetes Belt (DB) and non-Diabetes Belt (NDB) counties in providing recommended preventive care for Medicare beneficiaries with diabetes using available health professional resources and to understand county-level socioeconomic factors associated with inefficient provision of preventive care. A data envelopment analysis (DEA) model was developed to assess relative efficiency of counties in providing diabetes preventive care. Logistic regression was performed to identify socioeconomic characteristics associated with inefficiencies. We used Medicare claims data to extract individual-level information of diabetes preventive service use and obtained county-level estimates of health resources information from the Area Health Resources File. More than 80% of counties had more than 10% inefficiencies on average. Compared to counties in the NDB, the odds of being inefficient were 2.44 times more likely in the DB (OR 2.44, CI 1.67–3.58). Counties with lower median income, with a smaller proportion of non-Hispanic Black population, and in a rural area had higher odds of being inefficient in providing preventive care. Our DEA results showed that counties in the DB and NDB were mostly inefficient. The availability of care providers may be less of a problem than how efficiently the resources are used in providing preventive care. Identifying sources of inefficiency within each community with low resource utilization and developing targeted strategies is needed to improve uptake of preventive care cost-effectively.

Original languageEnglish (US)
Pages (from-to)200-210
Number of pages11
JournalHealth Services and Outcomes Research Methodology
Issue number2
Early online dateAug 9 2023
StatePublished - Jun 2024


  • Data envelopment analysis
  • Diabetes
  • Efficiency
  • Preventive care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Diabetes Belt has lower efficiency in providing diabetes preventive care than surrounding counties'. Together they form a unique fingerprint.

Cite this