The relationship between rural status, individual characteristics, and self-rated health in the Behavioral Risk Factor Surveillance System.

Purpose: 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.

Findings: 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.