1040. Differences in Health Status in Rural and Urban Veterans
William B Weeks, MD, MBA, White River Junction VAMC, LE Kazis, CHQOER, Bedford VAMC, Y Shen,
CHQOER, Bedford VAMC, Z Cong,
CHQOER, Bedford VAMC, AS Ren,
CHQOER, Bedford VAMC, D Miller,
CHQOER, Bedford VAMC, A Lee,
CHQOER, Bedford VAMC, JB Perlin,
VA Central Office
Objectives: VHA provides comprehensive health care services to veterans across the US through regional delivery networks. We sought to determine whether there are disparities in health related quality of life between veterans who live in rural settings and their suburban or urban counterparts.
Methods: We used the Veterans SF-36 health survey to determine health related quality of life scores (physical (PCS) and mental (MCS) health component summaries) for 767,109 veterans who had used VHA within the prior three years. We used Rural/Urban Commuting Area (RUCA) codes to categorize veterans into rural, suburban, or urban residence.
Results: Health status scores are lower for veterans who live in rural settings than for those who live in suburban or urban settings (respectively (with standard errors), PCS=33.5 (.03), 34.7 (.03), and 37.0 (.02), p<.001; MCS=44.5 (.03), 45.0 (.03), and 45.6 (.02), p<.001). Rural veterans had more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts (p<.001 for all). Rural-urban disparities persisted in all survey subscales, across regional delivery networks, and after controlling for sociodemographic factors.
Conclusions: When compared to their urban and suburban counterparts, veterans who live in a rural setting have worse physical and mental health related quality of life scores. Rural/urban differences within some service delivery networks and US census regions are substantial, denoting differences in patient needs.
Impact: Policymakers, within and outside of VHA, should anticipate greater health care demands from rural populations and pursue innovative strategies to meet their health care needs.