Skip to main content

Advertisement

SpringerLink
Log in

Racial and Ethnic Differences in Self-Rated Health Among Rural Residents

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

This study examines racial and ethnic differences in self-rated health among rural residents and whether these differences can be explained by socio-demographic characteristics. We used data from the 2011–2017 National Health Interview Survey to assess differences in self-rated health by race and ethnicity among rural residents (living in non-metropolitan counties; n = 46,883). We used logistic regression analyses to estimate the odds of reporting fair/poor health after adjusting for individual socio-demographic characteristics. Non-Hispanic Black and American Indian rural residents reported worse self-rated health than their non-Hispanic White counterparts (25.8% and 20.8% reporting fair/poor health, respectively, vs. 14.8%; p < 0.001). After adjusting for socio-demographic characteristics, disparities remained for non-Hispanic Black rural residents (Adjusted Odds Ratio = 1.55; 95% CI 1.36, 1.76). This study suggests more attention is required to address inequities among rural people and to develop policies to address structural racism and improve the health of all rural residents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Garcia, M. C., Faul, M., Massetti, G., et al. (2017). Reducing potentially excess deaths from the five leading causes of death in the rural United States. MMWR Surveillance Summaries, 66(2), 1–7. https://doi.org/10.15585/mmwr.ss6602a1.

    Article  PubMed Central  Google Scholar 

  2. Probst, J., Zahnd, W., & Breneman, C. (2019). Declines in pediatric mortality fall short for rural US children. Health Affairs, 38(12), 2069–2076. https://doi.org/10.1377/hlthaff.2019.00892.

    Article  PubMed  Google Scholar 

  3. Kozhimannil, K. B., Interrante, J. D., Henning-Smith, C., & Admon, L. K. (2019). Rural-urban differences in severe maternal morbidity and mortality in the US, 2007–15. Health Affairs, 38(12), 2077–2085. https://doi.org/10.1377/hlthaff.2019.00805.

    Article  PubMed  Google Scholar 

  4. Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to health care access in the rural USA. Public Health, 129(6), 611–620. https://doi.org/10.1016/j.puhe.2015.04.001.

    Article  CAS  PubMed  Google Scholar 

  5. Henning-Smith, C., & Kozhimannil, K. B. (2018). Rural–urban differences in risk factors for motor vehicle fatalities. Health Equity. https://doi.org/10.1089/heq.2018.0006.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Steelesmith, D. L., Fontanella, C. A., Campo, J. V., Bridge, J. A., Warren, K. L., & Root, E. D. (2019). Contextual factors associated with county-level suicide rates in the United States, 1999 to 2016. JAMA Network Open, 2(9), e1910936. https://doi.org/10.1001/jamanetworkopen.2019.10936.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Williams, D. R., & Sternthal, M. (2010). Understanding racial-ethnic disparities in health: Sociological contributions. Journal of Health and Social Behavior, 51(1_suppl), S15–S27. https://doi.org/10.1177/0022146510383838.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peters, R. M. (2004). Racism and hypertension among African Americans. Western Journal of Nursing Research, 26(6), 612–631. https://doi.org/10.1177/0193945904265816.

    Article  PubMed  Google Scholar 

  9. Krieger, N., Kosheleva, A., Waterman, P. D., Chen, J. T., & Koenen, K. (2011). Racial discrimination, psychological distress, and self-rated health among US-Born and Foreign-Born Black Americans. American Journal of Public Health, 101(9), 1704–1713.

    Article  Google Scholar 

  10. Hausmann, L. R., Kressin, N. R., Hanusa, B. H., & Ibrahim, S. A. (2010). Perceived racial discrimination in health care and its association with patients’ healthcare experiences: Does the measure matter? Ethnicity & Disease, 20(1), 40–47.

    Google Scholar 

  11. Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47. https://doi.org/10.1007/s10865-008-9185-0.

    Article  PubMed  Google Scholar 

  12. Singh, G. K., & Yu, S. M. (2019). Infant mortality in the United States, 1915–2017: Large social inequalities have persisted for over a century. International Journal of MCH and AIDS (IJMA), 8(1), 19–31. https://doi.org/10.21106/ijma.271.

    Article  Google Scholar 

  13. Centers for Disease Control and Prevention. (2019). Infant mortality. Retrieved Dec 20, 2019, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

  14. Hall, J. E., Moonesinghe, R., Bouye, K., & Penman-Aguilar, A. (2019). Racial/ethnic disparities in mortality: Contributions and variations by rurality in the United States, 2012–2015. International Journal of Environmental Research and Public Health, 16, 3. https://doi.org/10.3390/ijerph16030436.

    Article  Google Scholar 

  15. Henning-Smith, C. E., Hernandez, A. M., Hardeman, R. R., Ramirez, M. R., & Kozhimannil, K. B. (2019). Rural counties with majority black or indigenous populations suffer the highest rates of premature death in the US. Health Affairs, 38(12), 2019–2026. https://doi.org/10.1377/hlthaff.2019.00847.

    Article  PubMed  Google Scholar 

  16. Lichter, D. T. (2012). Immigration and the new racial diversity in rural America. Rural Sociology, 77(1), 3–35. https://doi.org/10.1111/j.1549-0831.2012.00070.x.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sharp, G., & Lee, B. A. (2017). New faces in rural places: Patterns and sources of nonmetropolitan ethnoracial diversity since 1990. Rural Sociology, 82(3), 411–443. https://doi.org/10.1111/ruso.12141.

    Article  PubMed  Google Scholar 

  18. Kozhimannil, K. B., & Henning-Smith, C. (2018). Racism and health in rural America. Journal of Health Care for the Poor and Underserved, 29(1), 35–43.

    Article  Google Scholar 

  19. Henning-Smith, C., Hernandez, A., Ramirez, M., Hardeman, R., & Kozhimannil, K. (2019). Dying too soon: County-level disparities in premature death by rurality, race, and ethnicity. Minneapolis. Retrieved December 10, 2019, from https://rhrc.umn.edu/publication/dying-too-soon-county-level-disparities-in-premature-death-by-rurality-race-and-ethnicity/

  20. James, W., & Cossman, J. S. (2017). Long-term trends in black and white mortality in the rural United States: Evidence of a race-specific rural mortality penalty. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 33(1), 21–31. https://doi.org/10.1111/jrh.12181.

    Article  Google Scholar 

  21. Bell, C. N., & Owens-Young, J. L. (2020). Self-rated health and structural racism indicated by county-level racial inequalities in socioeconomic status: The role of urban-rural classification. Journal of Urban Health. https://doi.org/10.1007/s11524-019-00389-7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. James, C. V, Moonesinghe, R., Wilson-Frederick, S. M., Hall, J. E., Penman-Aguilar, A., & Bouye, K. (2017). Racial and ethnic health disparities among rural adults—United States, 2012–2015. MMWR, 66(23), 1–9.

    PubMed  Google Scholar 

  23. Henning-Smith, C., Ramirez, M., Hernandez, A. M., Hardeman, R. R., & Kozhimannil, K. B. (2019). Differences in preventive care among rural residents by race and ethnicity. Retrieved December 10, 2019, from https://rhrc.umn.edu/publication/differences-in-preventive-care-among-rural-residents-by-race-and-ethnicity/

  24. Bonnar, K. K., & McCarthy, M. (2012). Health related quality of life in a rural area with low racial/ethnic density. Journal of Community Health, 37(1), 96–104. https://doi.org/10.1007/s10900-011-9422-2.

    Article  PubMed  Google Scholar 

  25. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21. https://doi.org/10.2307/2955359.

    Article  CAS  PubMed  Google Scholar 

  26. DeSalvo, K. B. (2006). Mortality prediction with a single general self-rated health question. Journal of General Internal Medicine, 21(3), 267. https://doi.org/10.1111/j.1525-1497.2005.00291.x.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nery Guimarães, J. M., Chor, D., Werneck, G. L., et al. (2012). Association between self-rated health and mortality: 10 years follow-up to the Pró-Saúdecohort study. BMC Public Health, 12(1), 676. https://doi.org/10.1186/1471-2458-12-676.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Blewett, L. A., Drew, J. A. R., Griffin, R., King, M. L., & Williams, K. (2018). IPUMS health surveys: National health interview survey: Version 6.3. Minneapolis, MN: University of Minnesota. https://doi.org/10.18128/D070.V6.3

  29. National Center for Health Statistics (2014). NCHS urban-rural classification scheme for counties. Retrieved October 8, 2019, from https://www.cdc.gov/nchs/data_access/urban_rural.htm

  30. Chae, D. H., & Walters, K. L. (2009). Racial discrimination and racial identity attitudes in relation to self-rated health and physical pain and impairment among two-spirit American Indians/Alaska Natives. American Journal of Public Health, 99(Suppl 1), S144–S151. https://doi.org/10.2105/AJPH.2007.126003.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thomeer, M. B. (2013). Sexual minority status and self-rated health: The importance of socioeconomic status, age, and sex. American Journal of Public Health, 103(5), 881–888. https://doi.org/10.2105/AJPH.2012.301040.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Womack, L. S., Rossen, L. M., & Hirai, A. H. (2019). Urban–rural infant mortality disparities by race and ethnicity and cause of death. American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2019.09.010.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. Lancet (London, England), 389(10077), 1453–1463. https://doi.org/10.1016/S0140-6736(17)30569-X.

    Article  Google Scholar 

  34. Hardeman, R. R., Medina, E. M., & Kozhimannil, K. B. (2016). Structural racism and supporting black lives—the role of health professionals. New England Journal of Medicine, 375(22), 2113–2115. https://doi.org/10.1056/NEJMp1609535.

    Article  Google Scholar 

  35. Henning-Smith, C., Shippee, T. P., McAlpine, D., Hardeman, R., & Farah, F. (2013). Stigma, discrimination, or symptomatology differences in self-reported mental health between US-born and Somalia-born Black Americans. American Journal of Public Health, 103(5), 861–867. https://doi.org/10.2105/AJPH.2012.301184;10.2105/AJPH.2012.301184.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Findling, M. G., Casey, L. S., Fryberg, S. A., Hafner, S., Blendon, R. J., Benson, J. M., et al. (2019). Discrimination in the United States: Experiences of native Americans. Health Services Research, 54(S2), 1431–1441. https://doi.org/10.1111/1475-6773.13224.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under PHS Grant No. 5U1CRH03717. The information, conclusions and opinions expressed in this manuscript are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Author information

Authors and Affiliations

  1. Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, 2221 University Ave., SE, Suite 350, Minneapolis, MN, 55414, USA

    Carrie Henning-Smith, Ashley M. Hernandez & Katy B. Kozhimannil

Authors
  1. Carrie Henning-Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley M. Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katy B. Kozhimannil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carrie Henning-Smith.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Henning-Smith, C., Hernandez, A.M. & Kozhimannil, K.B. Racial and Ethnic Differences in Self-Rated Health Among Rural Residents. J Community Health 46, 434–440 (2021). https://doi.org/10.1007/s10900-020-00914-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-020-00914-9

Keywords

Search

Navigation