Doctoral Dissertations

Date of Award

8-2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major Professor

Agricola Odoi

Committee Members

Russell Zaretzki, Marcy J. Souza, Kellie A. Fecteau

Abstract

Diabetes-related mortality is an important public health concern in Florida. However, little is known about geographic disparities, predictors, temporal trends, and future burden of diabetes-related mortality risks (DRMR), and yet this information is important for health planning and disease control efforts. Therefore, the objectives of this study were to identify: (a) geographic disparities and temporal changes; (b) county-level socioeconomic and demographic predictors; and (c) temporal patterns and future DRMR in Florida. This information is useful for guiding resource allocation aimed at reducing burden and health disparities associated with diabetes.

Retrospective mortality data from 1999 to 2023 were obtained from the Florida Department of Health and the Centers for Disease Control and Prevention WONDER database. The 10th International Classification of Disease codes E10-E14 were used to identify diabetes-related deaths which were aggregated to the county-level. County-level DRMRs were then computed and presented as number of deaths per 100,000 persons. Significant high-risk spatial clusters of DRMR were identified using Tango’s flexible spatial scan statistics and their geographic distribution displayed in choropleth maps. Ordinary least squares regression model was used to identify county-level predictors of DRMR. Time series analysis and forecasting of DRMR were performed using Seasonal Autoregressive Integrated Moving Average with Exogenous variable (SARIMAX) and Neural Network Autoregressive model with Exogenous variable (NNARX) time series models.

County-level DRMR varied by geographic location, ranging from 12.6 to 81.1 deaths per 100,000 persons. High DRMR clusters were identified in the northern and central counties of Florida. Counties with high percentages of population that were: 65 years and older (p< 0.001), current smokers (p=0.032), population with diabetes (p< 0.001), households without vehicles (p=0.022), and insufficiently physically active (p=0.036) tended to have high risks of DRMR. There were seasonal patterns of DRMR in Florida with the highest mortality risks recorded during the winter months. The DRMR forecast indicated a gradual increase for the next four years.

The study identified geographic disparities, predictors, seasonal patterns, and increasing temporal trends of DRMR in Florida. The findings are useful in guiding health planning and future intervention programs to reduce DRMR burden and disparities in Florida.

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