Explaining Rural/Non-rural Disparities in Physical Health-Related Quality of Life

Purpose: Researchers have documented lower health-related quality of life (HRQL) in rural areas. This study seeks to identify factors that can explain this disparity. Methods: United Methodist clergy in North Carolina (N = 1,513) completed the SF-12 measure of HRQL and items on chronic disease diagnoses, health behaviors, and health care access from the Behavioral Risk Factor Surveillance Survey (BRFSS). Differences in HRQL between rural (N= 571) and non-rural clergy (N = 942) were examined using multiple regression analyses. Results: Physical HRQL was significantly lower for rural clergy (-2.0; 95% CI: -2.9 to -1.1; p < .001). Income, body mass index, and joint disease partially accounted for the rural/non-rural difference, though a sizable disparity remained after controlling for these mediators (-1.02; 95% CI: 1.89 to -.15; p = .022). Mental HRQL did not differ significantly between rural and non-rural respondents (1.0, 95% CI: -0.1 to 2.1; p = .067). Conclusions: Rural/non-rural disparities in physical HRQL are partially explained by differences in income, obesity, and joint disease in rural areas. More research into the causes and prevention of these factors is needed. Researchers also should seek to identify variables that can explain the difference that remains after accounting for these variables.