The relationship between rural status, individual characteristics, and self-rated health in the Behavioral Risk Factor Surveillance System.
OBJECTIVE
To examine rural status and social factors as predictors of self-rated health in community-dwelling adults in the United States.


METHODS
This study uses multinomial logistic and cumulative logistic models to evaluate the associations of interest in the 2006 U.S. Behavioral Risk Factor Surveillance System, a cross-sectional survey of 347,709 noninstitutionalized adults.


RESULTS
Self-rated health was poorer among rural residents, compared to urban residents (OR = 1.77, 95% CI: 1.54, 1.90). However, underlying risk factors such as obesity, low income, and low educational attainment were found to vary by rural status and account for the observed increased risk (OR = 1.03, 95% CI: 0.94, 1.12). There was little evidence of effect modification by rural status, though the association between obesity and self-rated health was stronger among urban residents (OR = 2.50, 95% CI: 2.38, 2.64) than among rural residents (OR = 2.18, 95% CI: 2.03, 2.34).


CONCLUSIONS
Our findings suggest that differences in self-rated health by rural status were attributable to differential distributions of participant characteristics and not due to differential effects of those characteristics.
Slone Epidemiology Center, Boston University, Boston, Massachusetts 02215, USA. tnb@bu.edu
Traci N
TN
Bethea
Russell P
RP
Lopez
Yvette C
YC
Cozier
Laura F
LF
White
Michael D
MD
McClean
D000293:Adolescent; D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult