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Geographic distribution of childhood diabetes and obesity relative to the supply of pediatric endocrinologists in the United States.

Lee JM, Davis MM, Menon RK, Freed GL

Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, Michigan, USA.

OBJECTIVE: To determine the geographic distribution of childhood diabetes and obesity relative to the supply of US pediatric endocrinologists. STUDY DESIGN: Estimation of observed and "index" ratios of children with diabetes (by region and division) and obesity (body mass index >/=95th % for age and sex) (by region and state) to board-certified pediatric endocrinologists. RESULTS: At the national level, the ratio of children with diabetes to pediatric endocrinologists is 290:1, and the ratio of obese children to pediatric endocrinologists is 17,741:1. Ratios of children with diabetes to pediatric endocrinologists in the Midwest (370:1), South (335:1), and West (367:1) are twice as high as in the Northeast (144:1). Across states, there is up to a 19-fold difference in the observed ratios of obese children to pediatric endocrinologists. Under conditions of equitably distributed endocrinologist supply, variation across states would be mitigated considerably. CONCLUSIONS: The distribution of children with diabetes and obesity does not parallel the distribution of pediatric endocrinologists in the United States, due largely to geographic disparities in endocrinologist supply. Given the large burden of obese children to endocrinologists, multidisciplinary models of care delivery are essential for the US health care system to address the needs of children with diabetes and obesity.

Published 18 February 2008 in J Pediatr, 152(3): 331-6.
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