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The Relationship Between Rural Status, Individual Characteristics, and Self-Rated Health in the Behavioral Risk Factor Surveillance System


  • For further information, contact: Traci N. Bethea, PhD, Slone Epidemiology Center, Boston University, 1010 Commonwealth Avenue, 4th Floor, Boston, MA 02215; e-mail:

  • Funding: This research was funded by an NIEHS training grant: T32ES014562.

    Disclosures: The National Institute of Environmental Health Sciences (NIEHS) had no involvement in the study or the manuscript, including study design; collection, analysis, or interpretation of data; or writing or submission of the manuscript.

    Acknowledgments: The authors would like to thank the Centers for Disease Control and Prevention staff, specifically the Office of Surveillance, Epidemiology, and Laboratory Services, and participants of the Behavioral Risk Factor Surveillance System for providing the data for our work. We would also like to acknowledge Drs. Ema Rodrigues and Jessica Nelson for their assistance with statistical analyses and helpful comments. For further information, contact: Traci N. Bethea, Slone Epidemiology Center at Boston University, 1010 Commonwealth Ave. 4th floor, Boston, MA 02215; e-mail:


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 US 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.