# Prioritizing county-level social determinants that contribute to the greater burden of diabetes and hypertension in the US

> **NIH ALLCDC U01** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2021 · $557,366

## Abstract

PROJECT SUMMARY/ABSTRACT
Deaths from cardiovascular disease (CVD) have begun to increase in the US after decades of decline.
Although the reasons underlying this increase in CVD deaths are unclear, the prevention, detection, and
optimal treatment of CVD risk factors (i.e., diabetes and hypertension) will be essential for preventing any
further increases in CVD mortality. Currently, 14% of adults in the US have diabetes, of which 1 in 3 is
undiagnosed, and 29% of adults have hypertension. However, stark disparities exist in the CVD risk factor
burden, particularly by social determinants of health. These determinants are key contributors to the
development of diabetes and hypertension. Yet, they have largely been omitted from clinical practice and
decision-making. There is increasing awareness of the influence of social determinants on health outcomes,
but it is not clear exactly which factors should be assessed or how to integrate this information into current
practice. Social determinants of health are extensive, so it is important to characterize those that are likely to
have the greatest influence on the prevention, treatment and control of diabetes and hypertension and may be
used to inform the development of targeted programs and policies. We propose to investigate the community
and individual social determinants that contribute to a greater burden of diabetes and hypertension in the
southeastern US by leveraging national databases, the Medicare claims administrative database and the
infrastructure of a prospective cohort study, the NIH-funded Reasons for Geographic and Racial Differences in
Stroke (REGARDS) study, that enrolled 30,239 middle-aged and older adults in 2003-07. We will build upon
these resources to address the following aims: 1) determine the association of county-level social determinants
of health with the county-level prevalence and incidence of diabetes and hypertension, separately, in the
southeastern US; 2) evaluate the association of county-level social determinants of health with the county-level
prevalence and incidence of diabetes and hypertension, separately, among older adults in the southeastern
US using the Medicare database; and 3) evaluate the association of county-level and individual-level social
determinants of health with individual-level prevalent and incident diabetes and hypertension, separately,
among REGARDS participants in the southeastern US. This proposal will prioritize those social determinants
of health that are associated with a greater burden of diabetes and hypertension in the southeastern US and
help guide prevention programs and interventions to reduce this excess risk.

## Key facts

- **NIH application ID:** 10201403
- **Project number:** 5U01DP006302-05
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** April P Carson
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2021
- **Award amount:** $557,366
- **Award type:** 5
- **Project period:** 2017-09-30 → 2022-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10201403

## Citation

> US National Institutes of Health, RePORTER application 10201403, Prioritizing county-level social determinants that contribute to the greater burden of diabetes and hypertension in the US (5U01DP006302-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10201403. Licensed CC0.

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