{
  "abstract": "Diabetes prevalence varies across the United States, but individual versus state-level contributions remain unclear. We examined these predictors and survival bias. Using 2024 data from 406,782 adults in the United States Behavioral Risk Factor Surveillance System, we fitted multilevel logistic models for individual and state-level covariates. Age-stratified analyses tested survival bias. Individual obesity was the strongest predictor (OR = 2.33; 95% CI: 2.28, 2.38). Asian adults exhibited the highest risk (OR = 2.05; 95% CI: 1.91, 2.20), followed by Black (OR = 1.76) and Hispanic adults (OR = 1.54). State-level obesity independently predicted diabetes (OR = 1.38 per 10-point increase; 95% CI: 1.17, 1.63), explaining 57% of between-state variance. Individual obesity effects attenuated in higher-obesity states. Inverse associations for smoking (OR = 0.89; 95% CI: 0.86, 0.92) and binge drinking (OR = 0.62; 95% CI: 0.60, 0.65) were null in young adults but strengthened with age. State-level context independently elevates diabetes risk. Asian Americans face disproportionately high risk, supporting lower body mass index screening thresholds. Apparent protective effects of smoking and binge drinking reflect survival bias.",
  "abstract_shown": true,
  "affiliations": [
    "Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.",
    "Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.",
    "Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California, USA.",
    "University of California, Irvine, School of Medicine, Irvine, California, USA.",
    "Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.",
    "Research Center for Chronic Inflammatory Diseases, Tehran University of Medical Sciences, Tehran, Iran.",
    "Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Masoud Imani"
    },
    {
      "affs": [
        2
      ],
      "name": "Seyedshayan Shojaei"
    },
    {
      "affs": [
        3
      ],
      "name": "Kimia Heidari"
    },
    {
      "affs": [
        4
      ],
      "name": "Mohammad Javad Shabani"
    },
    {
      "affs": [
        4
      ],
      "name": "Hamid Mohsenabadi"
    },
    {
      "affs": [
        0
      ],
      "name": "Bagher Larijani"
    },
    {
      "affs": [
        0
      ],
      "name": "Mohammad Reza Mohajeri-Tehrani"
    },
    {
      "affs": [
        1,
        5,
        6
      ],
      "name": "Amir Kasaeian"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7g3a253h3v2sh.bib",
  "cited_by": 0,
  "doi": "10.1016/j.pmedr.2026.103688",
  "fulltext_url": "https://europepmc.org/articles/PMC13744371",
  "id": "7g3a253h3v2sh",
  "issns": [
    "2211-3355"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999737",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetes, Cardiovascular Risks, and Lipoproteins"
    ]
  ],
  "openalex": "W7224080958",
  "pdf_url": "https://europepmc.org/articles/PMC13744371?pdf=render",
  "pmcid": "PMC13744371",
  "pmid": "42999737",
  "published": "2026-10-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7g3a253h3v2sh.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:34Z",
      "native_id": "MED:42999737",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999737"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes, Cardiovascular Risks, and Lipoproteins",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Unmasking spatial disparities and survival bias in the United States diabetes prevalence: A multilevel analysis of individual and ecological determinants using the 2024 behavioral risk factor surveillance system.",
  "title_text": "Unmasking spatial disparities and survival bias in the United States diabetes prevalence: A multilevel analysis of individual and ecological determinants using the 2024 behavioral risk factor surveillance system.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/7g3a253h3v2sh",
  "venue": "Preventive medicine reports",
  "versions": []
}