. . . . . Health Disparities . . . . . ABSTRACT: Context: Hispanics are at increased risk for diabetes, while rural residents have historically had decreased access to care. Purpose: To determine whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes. Methods: We analyzed the Third National Health and Nutrition Examination Survey (1988-1994). Hispanics and non- Hispanic white adults were classified according to rural/ urban residence to create 4 ethnicity-residence groups. Investigated outcomes were previously diagnosed and undiagnosed diabetes. Among those with diagnosed diabetes, we investigated control of glucose, hypertension, and lipids. Findings: The prevalence of diagnosed diabetes was greatest for rural residents, especially for rural Hispanics (8.2%) versus that for urban whites (4.6%), rural whites (6.5%), or urban Hispanics (4.5%), (P < .01). However, urban Hispanics were most likely to have undiagnosed diabetes at 3.7%, versus 2.3% of rural whites, 2.8% of urban whites, and 2.7% of rural Hispanics (P = .04). Among people with diagnosed diabetes, there was no difference in glycemic control between the 4 groups. Rural Hispanics with diagnosed diabetes had the greatest prevalence of elevated systolic blood pressure at 45%, compared to 37% of urban whites, 29% of rural whites, 28% of urban Hispanics (P = .01). In regression models controlling for potential confounders, there were no differences among urban and rural whites and Hispanics in the likelihood of undiagnosed diabetes or in glycemic control for those with diagnosed diabetes. Conclusions: Initiatives that target Hispanic health, and especially diabetes, should acknowledge rural/urban Hispanic health differences. 1 Department of Family Medicine, Medical University of South Carolina, Charleston, SC. Supported by a grant from the Office of Rural Health Policy, grant 5 P30 AG21677 from the National Institute on Aging/National Institutes of Health, and grant 1D12HP00023-01 from the Health Resources and Services Administration. For further information, contact: Richelle J. Koopman, MD, MS, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St, PO Box 250192, Charleston, SC 29425; e-mail koopmanr@musc.edu. Rural Residence and Hispanic Ethnicity: Doubly Disadvantaged for Diabetes? Richelle J. Koopman, MD, MS; 1 Arch G. Mainous III, PhD; 1 and Mark E. Geesey, MS 1 diabetes for Mexican Americans in the United States was more than double that of white, non-Hispanic Americans (11.7% compared to 4.8%). 1 Rural and minority populations have historically had problems accessing care and are particularly vulnerable to the consequences of lower access to care. 5-10 Limited access to health care services results in fewer medical visits, underdiagnosis, lower rates of recommended monitoring tests for diabetes, and less optimal health outcomes. 11-15 Reducing access-to-care disparities can lead to improved outcomes indistinguishable from fully insured persons with full access. 16,17 Being minority and living in a rural area may have particular implications for access to health care. Evidence exists that there is an interaction between race and rural residence for health care outcomes. Although women in rural areas are less likely than urban women to have had a recent Pap test, 8 some data indicate that rural and urban white women are not different in their likelihood of receiving a Pap test, while rural African American women are less likely than urban African Americans to be screened. 18 Similarly, in a study of the relationship between race and rural/urban residence and diabetes control comparing whites and African Americans, rural African Americans with diabetes were significantly less likely than urban or rural whites to have optimal glycemic control. 19 Although the data suggest that Hispanics are more likely to have diabetes and that individuals living in rural areas have decreased access to care, it is unclear if being both Hispanic and living in a rural D iabetes mellitus is a common and potentially disabling chronic disease, affecting more than 16 million people in the United States. 1 Persons with diabetes are at increased risk for a number of serious complications, including retinopathy, renal disease, and heart disease. 2-4 Diabetes is a disease with substantial health disparities. For example, the 1999-2000 age- and sex-adjusted rate of diagnosed © 2006 National Rural Health Association 63 Winter 2006