The Centers for Disease Control and Prevention estimates that 29.1 million Americans today have diabetes. While diabetes is the seventh leading cause of death in the U.S., most cases of type 2 diabetes are preventable. Diabetes can be prevented by healthy eating, weight management, and an active lifestyle — factors which vary heavily by geography. An estimated 8.5% of adults in the San Francisco-Oakland-Hayward metro area have diabetes, less than the national share of 9.3% and the 11th largest share in California.

According to the CDC, more than one in three Americans is prediabetic. A person with prediabetes has blood sugar levels higher than normal, and is 15% to 30% more likely to develop diabetes within five years. Prediabetes is mostly caused by lifestyle factors such as diet and exercise, as well as risk factors such as age and family history. In San Francisco, some 14.9% of adults do not exercise outside of work, lower than the national share of 23.0% inactive Americans.

In inactive lifestyle can affect the likelihood of excess body fat, and a low share of inactive residents often results in a low obesity rate. In San Francisco, 19.5% of residents are obese, lower than the national rate of 27.0% and the second lowest of any California metro area.

Residents of San Francisco are also less likely to engage in other unhealthy behaviors. For example, the city’s 10.7% smoking rate and 17.6% excessive drinking rate are both lower than than the corresponding national rates of 17.0% and 18.0%.

Diabetes is often more prevalent in low-income areas where residents tend to have lower education levels. Individuals living in impoverished neighborhoods are less likely to have adequate access to healthy food, opportunities for exercise, or preventative health care. According to one study, residents of poor neighborhoods are up to twice as likely to have diabetes than those in wealthy neighborhoods.

In the San Francisco metro area, the typical household earns $88,518 annually, roughly $32,700 more than the national median household income of $55,775. An estimated 47.2% of adults in San Francisco have a bachelor’s degree, a larger share than the national college attainment rate of 30.6% and the second highest of any city in California.

Diabetes increases the risk of blindness, kidney failure, heart disease, and stroke. Ultimately, the risk of death is 50% higher for adults with diabetes than those without. Diabetes causes 76,600 deaths in the U.S. annually, or roughly 24 per 100,000 Americans. Overall, an estimated 474 in 100,000 Americans die prematurely before the age of 75 each year. In the San Francisco metro area, there are 242 deaths per 100,000 metro area residents, more than the national mortality rate and the third lowest of any city in California.