Diabetes rates have been on the rise for the last two decades, and show no sign of abating.

According to the Centers for Disease Control and Prevention, roughly 11.3% of the U.S. population suffers from diabetes—though many of those affected do not know they have the chronic illness.

Diabetes was the 8th leading cause of death in 2020, but the disease does not impact all Americans equally. Instead, variables like poverty level, geographic region, and race all influence diabetes rates, meaning some Americans are disproportionately impacted by the disease.

The Southeastern portion of the U.S. has a particularly high concentration of counties with elevated diabetes rates, with parts of Alabama, Mississippi, Tennessee, Pennsylvania, Texas, and nearly all of Louisiana, along with other states, facing some of the highest rates. Studies have shown that lack of access to healthy, affordable foods and health care services, exposure to environmental toxins, and other health hazards associated with poverty and systemic racism contribute to the increased likelihood of developing diabetes. These same conditions also mean that poor, non-white Americans are more likely to endure complications and have higher mortality rates from diabetes than wealthier white Americans with the disease.

The proportion of young people with diabetes is projected to increase over the next several decades, with racial, geographic, and socioeconomic disparities only growing larger if trends continue. Using 2022 County Health Rankings & Roadmaps from the University of Wisconsin Population Health Institute, Stacker identified the counties in Alabama with the highest percentage of adults with diabetes. Ties were broken by the broader Quality of Life rank provided by the analysis, which includes other poor physical and mental health indicators. The age-adjusted diabetes rate was obtained through the Behavioral Risk Factor Surveillance System.

5. Bullock County

– Estimated percentage of adults with diabetes: 18% (6 points higher than state percentage)

-Estimated county population: 9,976

4. Lowndes County

– Estimated percentage of adults with diabetes: 18% (6 points higher than state percentage)

– Estimated county population: 9,641

3. Perry County

– Estimated percentage of adults with diabetes: 19% (7 points higher than state percentage)

– Estimated county population: 8,687

2. Wilcox County

– Estimated percentage of adults with diabetes: 19% (7 points higher than state percentage)

– Estimated county population: 10,206

1. Greene County

– Estimated percentage of adults with diabetes: 21% (9 points higher than state percentage)

– Estimated county population: 7,990