Document Type
Article
Abstract
Background
Obesity disparities in the United States are well documented, but the limited body of research suggests that geographic factors may alter the magnitude of these disparities. A growing body of evidence has identified a “rural mortality penalty” where morbidity and mortality rates are higher in rural than urban areas, even after controlling for other factors. Black-White differences in health and mortality are more pronounced in rural areas than in urban areas.
Objective
Therefore, the purpose of this study was to explore how rural-urban status and region moderate Black-White health disparities in obesity.
Methods
Data were abstracted from the 2012 Behavioral Risk Factor Surveillance System, with the sample being restricted to Black and White respondents (n = 403,231). Respondents’ county of residence was linked to US Census information to obtain the county-level Index of Relative Rurality (IRR) and Census division. Crude and adjusted logistic regression models were utilized to assess the magnitude of Black-White disparities in having obesity (yes/no) by IRR quartile and by Census division.
Results
Overall, Black-White differences in obesity were wider in rural than in urban counties, with a significant linear trend (p < 0.001). Furthermore, when stratified by US Census division, results revealed that disparities were significantly wider in rural than urban areas for respondents living in the Middle Atlantic and South Atlantic divisions. In contrast, the association was reversed for the remaining divisions (New England, East North Central, West North Central, Mountain, and Pacific), where the magnitude of the Black-White difference was the largest in urban areas.
Conclusion
Findings highlight the need to understand and account for critical place-based factors that exacerbate racial obesity disparities to develop and maximize the effectiveness of policies and programs designed to reduce racial inequalities and improve population health.
Digital Object Identifier (DOI)
Publication Info
Published in Obesity Science and Practice, Volume 9, Issue 5, 2023, pages 516-528.
Rights
© 2023 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
APA Citation
Cohen, S. A., Brown, M. J., Xu, F., Nash, C. C., & Greaney, M. L. (2023). Geographic differences in the magnitude of black‐white disparities in having obesity. Obesity Science & Practice, 9(5), 516–528. https://doi.org/10.1002/osp4.679