title: Body Mass Index and Rural Status on Self-Reported Health in Older Adults: 2004-2013 Medicare Expenditure Panel Survey.
abstract: To ascertain whether rural status impacts self-reported health and whether the effect of rural status on self-reported health differs by obesity status.
  
  
  
  We identified 22,307 subjects aged ≥60 from the Medical Expenditure Panel Survey 2004-2013. Body mass index (BMI) was categorized as underweight, normal, overweight, or obese. Physical and mental component scores of the Short Form-12 assessed self-reported health status. Rural/urban status was defined using metropolitan statistical area. Weighted regression models ascertained the relative contribution of predictors (including rural and BMI) on each subscale.
  
  
  
  Mean age was 70.7 years. Rural settings had higher proportions classified as obese (30.7 vs 27.6%; P < .001), and rural residents had lower physical health status (41.7 ± 0.3) than urban (43.4 ± 0.1; P < .001). Obese or underweight persons had lower physical health status (39.5 ± 0.20 and 37.0 ± 0.82, respectively) than normal (44.7 ± 0.18) or overweight (44.6 ± 0.16) persons (P < .001). BMI category stratification was associated with differences in physical health between rural/urban by BMI. Individuals classified as underweight or obese had lower physical health compared to normal, while the differences were less pronounced for mental health. No differences in mental health existed between rural/urban status. A BMI*rural interaction was significant for physical but not mental health.
  
  
  
  Rural residents report lower self-reported physical health status compared to urban residents, particularly older adults who are obese or underweight. No interaction was observed between BMI and rural status.
authors.affiliation: Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.|Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.|The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.|Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire.
authors.forename: John A
authors.initials: JA
authors.lastname: Batsis
authors.affiliation: Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.|Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Whiteman
authors.affiliation: Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.|Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Lohman
authors.affiliation: The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire.|Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Scherer
authors.affiliation: The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.|Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire.|Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D006278:Medicare / Q000458:organization & administration / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States
keywords: health-related quality of life; obesity; older adults; rural