Adverse Childhood Experiences, Health‐Related Quality of Life, and Chronic Disease Risks in Rural Areas of the United States
Table 3
Logistic regression showing impact of ace scores on health outcomes among adults aged 18+ in rural and urban areas of the United States, 2011-2012 BRFSS, 9 states.
Rural Areas (n=29,521)
Score 0 n=13521
Score 1 n=6320
Score 2 n=3446
Score 3 n=2160
Score ≥4 n=4074
Activity Limitation Due to Physical, Mental, or Emotional (ref=no)
Unadjusted Prevalence (SE)
20.19 (0.55)
23.55 (0.86)
26.38 (1.27)
30.20 (1.68)
38.01 (1.34)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
General Health Rated as Fair/Poor (ref=excellent/very good/good)
Unadjusted Prevalence (SE)
16.56 (0.53)
17.46 (0.78)
19.11 (1.11)
20.95 (1.46)
27.92 (1.26)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.07 (0.94, 1.22)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
Ever Had Diabetes (ref=no diabetes)
Unadjusted Prevalence (SE)
11.68 (0.44)
11.69 (0.66)
11.74 (0.88)
12.58 (1.15)
10.82 (0.81)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.00 (0.86, 1.16)
1.01 (0.83, 1.21)
1.09 (0.87, 1.36)
0.92 (0.76, 1.10)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.17 (0.99, 1.38)
1.22 (0.99, 1.51)
1.12 (0.90, 1.41)
Ever Had Stroke (ref=no stroke)
Unadjusted Prevalence (SE)
3.74 (0.25)
3.77 (0.40)
2.82 (0.39)
3.69 (0.57)
3.81 (0.46)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.01 (0.78, 1.30)
0.75 (0.55, 1.02)
0.99 (0.70, 1.39)
1.02 (0.70, 1.35)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.26 (0.94, 1.68)
0.90 (0.62, 1.30)
1.22 (0.81, 1.85)
1.27 (0.90, 1.79)
Ever Diagnosed with Heart Attack (ref=no heart attack)
Unadjusted Prevalence (SE)
6.08 (0.32)
5.95 (0.45)
5.71 (0.64)
5.81 (0.70)
6.61 (0.75)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
0.98 (0.81, 1.19)
0.94 (0.72, 1.21)
0.95 (0.72, 1.25)
1.09 (0.84, 1.42)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.20 (0.96, 1.49)
1.31 (0.96, 1.78)
Ever Had Angina or Coronary Heart Disease (ref=no heart disease)
Unadjusted Prevalence (SE)
5.40 (0.29)
6.67 (0.51)
6.7 (0.76)
5.6 (0.65)
6.8 (0.74)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.27 (0.98, 1.65)
1.03 (0.79, 1.35)
1.27 (0.98, 1.64)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
Ever Had Asthma (ref=no asthma)
Unadjusted Prevalence (SE)
8.38 (0.47)
10.64 (0.70)
11.07 (0.89)
13.87 (0.13)
18.29 (0.11)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.22 (1.00, 1.48)
1.22 (0.96, 1.56)
Poor Mental Health (ref=good mental health)
Unadjusted Prevalence (SE)
27.20 (1.42)
30.3 (1.89)
29.51 (2.33)
37.24 (2.97)
46.03 (1.98)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.17 (0.93, 1.46)
1.12 (0.86, 1.45)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.20 (0.94, 1.53)
1.19 (0.90, 1.57)
Urban Areas (n=36,141)
Score 0 n=15457
Score 1 n=8057
Score 2 n=4510
Score 3 n=2823
Score≥4 n=5294
Activity Limitation Due to Physical, Mental, or Emotional (ref=no)
Unadjusted Prevalence (SE)
18.67 (0.46)
23.08 (0.77)
25.65 (1.02)
27.69 (1.31)
35.73 (1.11)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
General Health Rated as Fair/Poor (ref=excellent/very good/good)
Unadjusted Prevalence (SE)
13.43 (0.47)
14.00 (0.66)
15.25 (0.87)
20.48 (1.25)
23.06 (0.94)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.05 (0.92, 1.19)
1.16 (1.00, 1.35)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.07 (0.92, 1.25)
1.21 (1.00, 1.46)
Ever Had Diabetes (ref=no diabetes)
Unadjusted Prevalence (SE)
10.76 (0.37)
10.41 (0.54)
11.37 (0.75)
13.64 (1.10)
11.55 (0.66)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
0.96 (0.84, 1.10)
1.06 (0.90, 1.25)
1.08 (0.94, 1.25)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.09 (0.94, 1.27)
Ever Had Stroke (ref=no stroke)
Unadjusted Prevalence (SE)
2.89 (0.18)
3.09 (0.28)
2.84 (0.39)
4.00 (0.73)
3.37 (0.34)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.07 (0.86, 1.34)
0.98 (0.73, 1.33)
1.40 (0.95, 2.07)
1.17 (0.92, 1.49)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.24 (0.97, 1.59)
1.22 (0.88, 1.69)
1.47 (0.97, 2.23)
Ever Diagnosed with Heart Attack (ref=no heart attack)
Unadjusted Prevalence (SE)
5.15 (0.27)
5.11 (0.44)
4.17 (0.45)
5.71 (0.80)
4.72 (0.41)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
0.99 (0.80, 1.22)
0.80 (0.63, 1.02)
1.11 (0.82, 1.52)
0.91 (0.74, 1.12)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.18 (0.94, 1.49)
1.05 (0.80, 1.37)
Ever Had Angina or Coronary Heart Disease (ref=no heart disease)
Unadjusted Prevalence (SE)
5.22 (0.27)
5.14 (0.41)
4.84 (0.48)
5.06 (0.77)
4.58 (0.39)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
0.98 (0.81, 1.20)
0.92 (0.74, 1.16)
0.97 (0.69, 1.35)
0.87 (0.71, 1.07)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.18 (0.94, 1.47)
1.23 (0.95, 1.59)
1.32 (0.93, 1.88)
Ever Had Asthma (ref=no asthma)
Unadjusted Prevalence (SE)
8.30 (0.40)
11.59 (0.64)
13.07 (0.90)
13.61 (1.11)
17.62 (0.88)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
0.98 (0.81, 1.20)
0.92 (0.74, 1.16)
0.97 (0.69, 1.35)
0.87 (0.71, 1.07)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
Poor Mental Health (ref=good mental health)
Unadjusted Prevalence (SE)
25.13 (1.26)
25.63 (1.61)
28.84 (2.01)
31.50 (2.15)
42.90 (1.62)
Unadjusted Odds Ratio (OR)
1.00 (Reference)
1.03 (0.83, 1.27)
1.21 (0.96, 1.52)
Adjusted Odds Ratio (AOR)1
1.00 (Reference)
1.07 (0.85, 1.35)
1.12 (0.85, 1.47)
1.30 (1.00, 1.70)
for age, sex, race/ethnicity, veteran status, marital status, employment status, education, and family income. <.01, <.05.
