Diabetes Burden in NCT
Overview — What the Data Measures
YLLs (Years of Life Lost) measure premature mortality — years a person would have lived had they not died early from diabetes. Expressed as a rate per 100,000 population across 24 Texas counties, 2000–2019.
| Metric | Value |
|---|---|
| Avg YLL Rate | 423 per 100K |
| Peak Rate | 870 — Brown County, 2005 |
| Lowest Rate | 112 — Collin County |
| Disparity Ratio | 7.75× highest vs. lowest county (2019) |
Key Finding: Non-Latino Black residents bear nearly 4× the YLL burden of Non-Latino Asian/Pacific Islander residents — the starkest racial disparity across all 24 counties in 2019 (507 vs. 129 per 100,000).
20-Year Trend: Rise, Peak & Partial Recovery
| Year | Avg Rate | Event |
|---|---|---|
| 2000 | 450.9 | Baseline — burden already high in rural counties |
| 2005 | 489.8 | Peak — Brown County hits 870, rural crisis |
| 2013 | 348.1 | Best — 29% drop, ACA + better medication access |
| 2019 | 396.9 | Rebound — +14% from low, obesity + aging pressure |
The 2005–2013 decline reflects expanded healthcare access and improved diabetes medications. Texas’s decision not to expand Medicaid under the ACA likely contributed to the post-2013 rebound.
Racial Disparities (2019, Adults 20+)
| Ethnicity | YLL Rate |
|---|---|
| Non-Latino, Black | 507 |
| Non-Latino, White | 424 |
| Total (All ethnicities) | 397 |
| Latino, Any ethnicity | 259 |
| Am. Indian / Alaska Native | 234 |
| Asian / Pacific Islander | 129 |
The Latino Paradox: Despite socioeconomic disadvantages, Latino residents show lower rates than Non-Latino White and Black populations — possibly due to stronger social networks, dietary practices, or selective migration effects.
Geography: Rural vs. Urban (2019)
Rural avg: 564 YLLs vs Urban avg: 231 YLLs — a 2.4× gap
| County | YLL Rate | Tier |
|---|---|---|
| Brown County | 701 | High |
| Eastland County | 593 | High |
| Navarro County | 565 | High |
| Dallas County | 278 | Moderate |
| Denton County | 202 | Low |
| Rockwall County | 174 | Low |
| Collin County | 134 | Lowest |
Age Distribution (2019)
Burden rises sharply with age, peaking in the 75–79 bracket, with early warning signs emerging in the 40–54 group.
| Age Group | YLL Rate |
|---|---|
| 75–79 years | 878 |
| 70–74 years | 856 |
| 65–69 years | 784 |
| 55–59 years | 560 |
| 45–49 years | 302 |
| 40–44 years | 117 |
Strengths & Limitations
Strengths
- 20-year longitudinal data — rare at county level
- Ethnicity-stratified data exposes systemic health disparities
- YLL metric captures years of productive life lost
- FIPS-coded geography enables precise Tableau mapping
- Spans both urban (DFW metro) and rural counties
- Confidence intervals provided for statistical rigor
Limitations
- Only combined genders (Both) — no male vs. female breakdown
- Single cause only — comorbidities like obesity not captured
- Ends at 2019 — COVID-19 impact not reflected
- Small rural populations create wide confidence intervals
- No socioeconomic variables to contextualize racial disparities
- County-level too coarse for neighborhood analysis
Policy Recommendations
Target Rural Counties First — Brown, Eastland, Navarro show 2–3× metro rates. Mobile screening clinics and telehealth endocrinology yield highest ROI.
Address Racial Fairness — Non-Latino Black communities need culturally tailored interventions addressing social determinants of health.
Prioritize Aging Population — 65–79 age group accounts for disproportionate YLLs. Expand Medicare-enrolled diabetes management programs