2361-P: Rural–Urban Differences in Diabetes and Obesity Prevalence in the United States, 2018–2024

Introduction and Objective: Geographic differences continue to shape chronic diseases patterns in the United States. Despite improvements in prevention and disease management, rural-urban disparities in cardiometabolic conditions persist and remain poorly characterized. This study examines the association between rurality and the prevalence of diabetes and obesity by race and ethnicity among U.S. adults. Methods: We analyzed cross-sectional data (2018-2024) of the Behavioral Risk Factor Surveillance System, a nationally representative survey of self-reported health conditions and behaviors. Survey-weighted Poisson regression with robust variance was used to estimate age-adjusted prevalence and prevalence ratios (PRs) by rurality and race stratification. Results: Among 2,971,000 participants, 14% lived in rural areas. Rural residents had a higher diabetes (10-18%) and obesity (16-20%) prevalence than urban residents (PR: 1.10-1.18; 1.16-1.20). Differences were stable over time and significant among non-Hispanic (NH) Black and White adults, with the highest prevalence among NH Black adults. Differences were variable or absent in other racial groups. Conclusion: Over the past 7 years, rural residents have experienced a higher burden of diabetes and obesity, with the most persistently large differences among NH Black and White adults. These findings underscore the critical role of place-based factors and the need for targeted efforts to improve cardiometabolic health. Disclosure M.O. Ezeude: None. M. Hashemian: None. G. Henriquez-Santos: None. V.L. Roger: None.