Skip to main content

Advertisement

SpringerLink
Log in

Explaining rural/non-rural disparities in physical health-related quality of life: a study of United Methodist clergy in North Carolina

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

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 < 0.001). 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 = 0.022). Mental HRQL did not differ significantly between rural and non-rural respondents (1.0, 95% CI: −0.1 to 2.1; P = 0.067).

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.

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

Abbreviations

HRQL:

Health-related quality of life

BMI:

Body-mass index

NC:

North Carolina

UMC:

United Methodist Church

SF-12:

MOS short-form 12 health survey

MCS:

Mental component score

PCS:

Physical component score

SD:

Standard deviation

PHQ-9:

Patient health questionnaire

HADS:

Hospital anxiety and depression scale

BRFSS:

Behavioral risk factor surveillance system

References

  1. Weeks, W. B., Kazis, L. E., Shen, Y., et al. (2001). Differences in health-related quality of life in rural and urban veterans. American Journal of Public Health, 94(10), 1762–1767.

    Article  Google Scholar 

  2. Weeks, W. B., Wallace, A. E., Wang, S., Lee, A., & Kazis, L. E. (2006). Rural-urban disparities in health-related quality of life within disease categories of veterans. Journal of Rural Health, 22(3), 204–211.

    Article  PubMed  Google Scholar 

  3. Kovac, S. H., Mikuls, T. R., Mudano, A., & Saag, K. G. (2006). Health-related quality of life among self-reported arthritis sufferers: Effects of race/ethnicity and residence. Quality of Life Research, 15(3), 451–460.

    Article  PubMed  Google Scholar 

  4. Oguzturk, O. (2008). Differences in quality of life in rural and urban populations. Clinical and Investigative Medicine, 31(6), E346–E350.

    PubMed  Google Scholar 

  5. Krivo, L. J., Peterson, R. D., Rizzo, H., & Reynolds, J. R. (1998). Race, segregation, and the concentration of disadvantage: 1980–1990. Social Problems, 45(1), 61–80.

    Article  Google Scholar 

  6. Hausdorf, K., Rogers, C., Whiteman, D., et al. (2008). Rating access to health care: Are there differences according to geographical region? Australian and New Zealand Journal of Public Health, 32(3), 246–249.

    Article  PubMed  Google Scholar 

  7. Laditka, J. N., Laditka, S. B., & Probst, J. C. (2009). Health care access in rural areas: Evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality. Health & Place, 15(3), 731–740.

    Article  Google Scholar 

  8. Litaker, D., Koroukian, S. M., & Love, T. E. (2005). Context and healthcare access: Looking beyond the individual. Medical Care, 43(6), 531–540.

    Article  PubMed  Google Scholar 

  9. Merwin, E., Snyder, A., & Katz, E. (2006). Differential access to quality rural healthcare: Professional and policy challenges. Family & Community Health, 29(3), 186–194.

    Google Scholar 

  10. Probst, J. C., Laditka, S. B., Wang, J., Johnson, A. O. (2007). Effects of residence and race on burden of travel for care: Cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Services Research, 7(40).

  11. Reschovsky, J. D., & Staiti, A. B. (2005). Access and quality: Does rural America lag behind? Health Affairs, 24(4), 1128–1139.

    Article  PubMed  Google Scholar 

  12. Stearns, S. C., Slifkin, R. T., & Edin, H. M. (2000). Access to care for rural medicare beneficiaries. Journal of Rural Health, 16(1), 31–42.

    Article  PubMed  CAS  Google Scholar 

  13. Zollinger, T., Saywell, R., Smith, M., Robinson, R., & Knudson, N. (2000). Children’s special health care services program: Impact of administrative changes on rural needs. Children’s Health Care, 29(4), 295–311.

    Article  Google Scholar 

  14. (2008). The book of discipline of the United Methodist Church (pp. 398–401). Nashville, T.N.: The United Methodist Publishing House.

  15. Bronstein, J. M., Johnson, V. A., & Fargason, C. A. (1997). How rural physicians compare on cost and quality measures for Medicaid ambulatory care episodes. Journal of Rural Health, 13(2), 126–135.

    Article  PubMed  CAS  Google Scholar 

  16. Ware, J. E., Kosinski, M., & Keller, S. (1998). SF-12: How to score the SF-12 physical and mental health summary scales. 3rd. Lincoln, RI: QualityMetric Inc.

    Google Scholar 

  17. Andrews, G., Henderson, S., & Hall, W. (2001). Prevalence, comorbidity, disability and service utilization: Overview of the Australian National Mental Health Survey. British Journal of Psychiatry, 178, 145–153.

    Article  PubMed  CAS  Google Scholar 

  18. Ciechanowski, P. S., Katon, W. J., & Russo, J. E. (2000). Depression and diabetes: Impact of depressive symptoms on adherence, function, and cost. Archives of Internal Medicine, 160(21), 3278–3285.

    Article  PubMed  CAS  Google Scholar 

  19. Sanderson, K., Andrews, G., & Jelsma, W. (2001). Disability measurement in the anxiety disorders: Comparison of three brief measures. Journal of Anxiety Disorders, 15(4), 333–344.

    Article  PubMed  CAS  Google Scholar 

  20. Zigmond, A., & Snaith, R. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.

    Article  PubMed  CAS  Google Scholar 

  21. Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.

    Article  PubMed  Google Scholar 

  22. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

    Article  PubMed  CAS  Google Scholar 

  23. Stafford, L., Berk, M., & Jackson, H. J. (2007). Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. General Hospital Psychiatry, 29(5), 417–424.

    Article  PubMed  Google Scholar 

  24. Sheps, C. G. (n.d.) Persistent Health Professional Shortage Areas (PHPSAs) North Carolina, 2005. Available at: (http://www.shepscenter.unc.edu/research_programs/rural_program/maps.html). Accessed 2 June 2009.

  25. MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614.

    Article  PubMed  Google Scholar 

  26. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.

    Article  PubMed  CAS  Google Scholar 

  27. Long, J. S., & Ervin, L. H. (2000). Using heteroscedasticity consistent standard errors in the linear regression model. The American Statistician, 54(3), 217–224.

    Article  Google Scholar 

  28. Bliese, P. (2008). multilevel: Multilevel functions. R package version 2.3. Available at: http://cran.r-project.org/package=multilevel. Accessed 4 Oct 2010.

  29. DebRoy, S., Bivand, R., et al. (2009). foreign: Read data stored by Minitab, S, SAS, SPSS, Stata, Systat, dBase,…. R package version 0.8-37. Available at: http://cran.r-project.org/package=foreign. Accessed 4 Oct 2010.

  30. Fox. J. (2009). car: Companion to applied regression. R package version 1.2-15. Available at: http://cran.r-project.org/package=car. Accessed 4 Oct 2010.

  31. Harrell, F. E., with contributions from many other users. (2009). Hmisc: Harrell miscellaneous. R package version 3.7-0. Available at: http://cran.r-project.org/package=Hmisc. Accessed 4 Oct 2010.

  32. Warnes, G. R. (2006). gregmisc: Greg’s miscellaneous functions. R package version 2.1.1. Available at: http://cran.r-project.org/package=gregmisc. Accessed 4 Oct 2010.

  33. Zeileis, A. (2004). Econometric computing with HC and HAC covariance matrix estimators. Journal of Statistical Software, 11(10), 1–17.

    Google Scholar 

  34. Zeileis, A. (2006). Object-oriented computation of sandwich estimators. Journal of Statistical Software, 16(9), 1–16.

    Google Scholar 

  35. R Development Core Team. (2009). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. ISBN 3-900051-07-0. Available at: http://www.r-project.org. Accessed 4 Oct 2010.

  36. Ware, J., Kosinski, M., Turner-Bowker, D., & Gandek, B. (2002). SF-12v2: How to score version 2 of the SF-12 health survey (with a supplement documenting version 1). Lincoln, RI: QualityMetric Inc.

    Google Scholar 

  37. Brambor, T., Clark, W. R., & Golder, M. (2005). Understanding interaction models: Improving empirical analyses. Political Analysis, 14(1), 63–82.

    Article  Google Scholar 

  38. Hosler, A. S. (2009). Retail food availability, obesity, and cigarette smoking in rural communities. Journal of Rural Health, 25(2), 203–210.

    Article  PubMed  Google Scholar 

  39. Jackson, J. E., Doescher, M. P., Jerant, A. F., & Hart, L. G. (2005). A national study of obesity prevalence and trends by type of rural county. Journal of Rural Health, 21(2), 140–148.

    Article  PubMed  Google Scholar 

  40. Joens-Matre, R. R., Welk, G. J., Calabro, M. A., et al. (2008). Rural–urban differences in physical activity, physical fitness, and overweight prevalence of children. Journal of Rural Health, 24(1), 49–54.

    Article  PubMed  Google Scholar 

  41. Patterson, P. D., Moore, C. G., Probst, J. C., & Shinogle, J. A. (2004). Obesity and physical inactivity in rural America. Journal of Rural Health, 20(2), 151–159.

    Article  PubMed  Google Scholar 

  42. Cha, E. S., Kong, K. A., Moon, E. K., & Lee, W. J. (2009). Prevalence and changes in chronic diseases among South Korean farmers: 1998 to 2005. BMC Public Health, 9, 268.

    Article  PubMed  Google Scholar 

  43. Joshi, V. L., & Chopra, A. (2009). Is there an urban-rural divide? Population surveys of rheumatic musculoskeletal disorders in the Pune region of India using the COPCORD Bhigwan model. The Journal of Rheumatology, 36(3), 614–622.

    Article  PubMed  Google Scholar 

  44. Callahan, L. F., Shreffler, J., Mielenz, T., et al. (2008). Arthritis in the family practice setting: Associations with education and community poverty. Arthritis and Rheumatism, 59(7), 1002–1008.

    Article  PubMed  Google Scholar 

  45. Cvijetić, S., Kurtagić, N., & Ozegović, D. D. (2004). Osteoarthritis of the hands in the rural population: A follow-up study. European Journal of Epidemiology, 19(7), 687–691.

    Article  PubMed  Google Scholar 

  46. Lee, D., Steffes, M., & Jacobs, D. R. (2007). Positive associations of serum concentration of polychlorinated biphenyls or organochlorine pesticides with self-reported arthritis, especially rheumatoid type, in women. Environmental Health Perspectives, 115(6), 883–888.

    Article  PubMed  CAS  Google Scholar 

  47. Tickamyer, A. R., & Duncan, C. M. (1990). Poverty and opportunity structure in rural America. Annual Review of Sociology, 16(1), 67–86.

    Article  Google Scholar 

  48. (2010). Rural poverty persists. State Legislatures, 36(4), 6.

Download references

Acknowledgments

We are deeply indebted to the clergy persons who completed this survey. We also thank The Reverend Jeremy Troxler for his insightful comments on rural ministry and John James for assistance with the conference data. This research was funded by a grant from the Rural Church Area of The Duke Endowment.

Author information

Authors and Affiliations

  1. Department of Sociology, Duke University, Durham, NC, USA

    Andrew Miles

  2. Duke Global Health Institute, Duke University, Durham, NC, USA

    Rae Jean Proescholdbell & Eve Puffer

  3. Duke Center for Health Policy, Duke University, Durham, NC, USA

    Rae Jean Proescholdbell

Authors
  1. Andrew Miles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rae Jean Proescholdbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eve Puffer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew Miles.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miles, A., Proescholdbell, R.J. & Puffer, E. Explaining rural/non-rural disparities in physical health-related quality of life: a study of United Methodist clergy in North Carolina. Qual Life Res 20, 807–815 (2011). https://doi.org/10.1007/s11136-010-9817-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-010-9817-z

Keywords

Search

Navigation