The Development of a Model to Examine Diabetes Burden by School District to Inform School-Based Diabetes Risk Program Planning and Evaluation

Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Amy B. Curtis

Second Advisor

Dr. Kathleen M. Baker

Third Advisor

Dr. Rajib Paul


Diabetes, school district, GIS, YPLL, mortality rate, mapping


Although diabetes prevalence has plateaued in the last several years, it remains high. Diabetes was also the seventh leading cause of death nationwide in 2014 with type 2 diabetes accounting for approximately more than 90% of diabetes cases in the U.S. It is a complex disease resulting from an interaction between non-modifiable (genetic) and modifiable (lifestyle and environmental factors) risk factors. To decrease diabetes morbidity and mortality rates, early interventions are needed to change lifestyles that are often cemented early, making school-based interventions important. However, with limited resources and a lack of within-county diabetes data, it is difficult to determine specific local areas for intervention. To address this issue, this three paper dissertation aims to examine diabetes burden by school district to provide information for school-based diabetes prevention interventions.

Michigan death records from 2007 to 2014 with diabetes-related deaths were identified. All individual deaths were address matched to the Michigan road network using GIS. Diabetes-related mortality rates were age-standardized by the direct method using the standardized 2000 U.S. population. Years of potential life lost (YPLL) were calculated. Correlation analysis was performed using SPSS v. 22. Choropleth maps were created using ArcMap 10.3.1. Local Moran’s I was used to analyze local clusters of diabetes-related mortality rate using Geoda. The space time trend analysis was conducted using space time pattern mining tools in ArcGIS Pro.

The first paper analyzed and mapped diabetes-related mortality rate, diabetes prevalence and YPLL by school district in 13 cities in Michigan (> 50,000 metropolitan statistical area population) using death records and data from the CDC’s 500 Cities Project. The study results indicated geographic variation of diabetes death rates, prevalence, and YPLL across the cities and that death records could be used as a proxy to describe diabetes burden when diabetes prevalence data are not available.

The second paper was based on the finding from the first paper and extended to the entire state of Michigan by analyzing and mapping diabetes-related mortality rate and YPLL by school district. The study shows that the age adjusted diabetes-related mortality rate and YPLL clustered in East Central and Southeastern region of Lower Peninsula Michigan. The following districts were identified for priority in targeting school-based diabetes prevention programs: Flint, Kearsley, Beecher, Westwood Heights, Detroit, Ecorse, River Rouge, Taylor, Allen Park and Lincoln.

The third paper analyzed the space and time trends of diabetes-related mortality by school district in the state of Michigan from 2007 to 2014. The study revealed the intensifying and new hotspots of diabetes located in central and Southeastern region of Lower Peninsula. Taken together, these three papers offer insight into using school district as one of the geographic analysis at sub-county level to provide information for local officials that is useful for public health planning and evaluation, particularly school-based diabetes prevention programs.

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