Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey

Abstract

Background Racial health disparities in obesity and obesity-related conditions and behaviors are well documented, although a small body of research suggests that geographic factors (e.g., socioeconomic status [SES] and rural/urban status) may alter the magnitude of these disparities. Methods This study explored how rurality moderates black/white health disparities using a nationally representative sample from the 2012 Behavioral Risk Factor Surveillance System ( n =359,157). Respondents' county of residence was linked to the U.S. Census information to obtain the county-level Index of Relative Rurality (IRR). Weighted logistic regression was used to model obesity, diabetes, and lack of physical activity (PA) on race (black/white), IRR, and an interaction term of race and IRR, including covariates (age, sex, education, marital status, employment, and income). Results Blacks were significantly more likely to have obesity, diabetes, and a lack of PA compared with whites. Irrespective of race, rural respondents were significantly more likely to have obesity (odds ratio [OR] 1.035, confidence interval [95% CI] 1.028–1.043) and a lack of PA (OR 1.045, 95% CI 1.038–1.053) than respondents in more urban areas. For obesity and diabetes, the interaction term for black×IRR quintile was significant and positive, indicating an increase in the magnitude of the black/white disparity with increasing rurality. Discussion These findings underscore the need for policies and programs aimed to reduce racial disparities in obesity and related conditions to consider the geographic context in which these outcomes occur.

Geographic differences in the magnitude of black‐white disparities in having obesity

“…Black‐White differences in mortality are widest in rural areas, and those differences have widened over time 55 . Similar results have been found with obesity: rural areas have the highest rates of obesity, but also Black‐White differences in the rates of having obesity are largest in rural areas 56 . Furthermore, a 2021 study 57 found critical regional differences in the rural health and mortality penalty in the US, where rural mortality rates are worse in the rural south compared to other rural areas.…”

Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide Inpatient Sample analysis from 1993 to 2017

“… 26 The effect of comorbidities on race disparity was hypothesized, as there is evidence that African Americans are more likely to experience comorbidities such as obesity and diabetes compared to white patients. 11 , 27 However, previous studies aimed at investigating this hypothesis found that the number of comorbidities does not significantly contribute to racial disparities in DBS utilization for PD patients. 3 , 11 Our findings revealed that the ET-DBS cohort had a significantly higher proportion of patients with moderate number of comorbidities compared to the PD-DBS cohort (32.5% vs %24%), indicating more liberal selection criteria for DBS surgery among ET patients than PD patients.…”

Aging in Rural Communities

“…One such measure is the Index of Relative Rurality (IRR) [49], which is calculated using population size, population density, distance to nearest metropolitan area, and percent urban population. The IRR has been used in several recent studies on health and aging, including health services utilization [50], geographic inequities in healthcare providers [51], availability of hospice care [52], opioid prescribing patterns [53], obesity [54], and COVID-19-related outcomes [55,56].…”

“…A 2019 study showed that although White rural older adults reported less social isolation than their urban counterparts, the association was reversed among some racial and ethnic minorities, where rural Black older adults experienced significantly greater social isolation than urban Black older adults [178]. Another recent study found that the well-documented Black-White differences in obesity were significantly worse in rural areas compared to urban areas [54].…”