Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3008 — Rural/Urban Disparities in Health-Related Quality of Life

Author List:
Wallace AE (VAMC WRJ, VT)
Weeks WB (VAMC WRJ, VT)
Wang S (VAMC Bedford, MA)
Lee AF (VAMC Bedford, MA)
Kazis LE (VAMC Bedford, MA)

Objectives:
We previously demonstrated that rural veterans experience poorer health-related quality of life compared to veterans who live in urban settings. We wanted to determine whether rural/urban disparities in health-related quality of life persisted when examining veterans with common psychiatric disorders.

Methods:
We examined a cohort of 748,216 current or anticipated VA users who completed the Veterans SF-36 health survey in 1999. From the survey, we determined health-related quality of life scores (both physical (PCS) and mental (MCS) health component summaries) and we used ICD-9-CM codes to identify veterans with six mental health disorders. Using Rural/Urban Commuting Area (RUCA) codes to determine rural or urban residence, we compared prevalence of psychiatric illness and health-related quality of life across rural and urban groups.

Results:
All mental disorders except non-PTSD anxiety disorders were more prevalent in urban settings; odds ratios ranged from 0.90 (95% CI: 0.89-0.92) for depression and PTSD (95% CI: 0.87-0.92) to 0.57 (95% CI: 0.54-0.59) for schizophrenia. However, within mental illness cohorts, rural veterans reported worse physical and mental health-related quality of life scores. Differences in PCS scores were substantial, ranging between 2.27 for schizophrenia and 3.39 for alcohol dependence (p<.001 for all diagnoses). Differences in MCS scores were statistically significant, but modest, and ranged from 0.74 for schizophrenia to 1.97 for PTSD (p<.001 for all diagnoses). Because lower scores are associated with increased resource consumption, the differences we found translate into higher average annual costs of up to 10.9% due to lower PCS scores and 3.7% due to lower MCS scores. In regression models, rural-urban disparities within disease cohorts persisted after controlling for socio-demographic factors.

Implications:
Although less likely than their urban counterparts to have mental disorders, rural veterans with mental illness experience a greater disease burden and are likely to incur greater healthcare costs.

Impacts:
Lower quality of life scores among rural patients with mental illness may reflect restricted access to healthcare in rural areas. Improving access for veterans who live in rural settings, through expansion of distance technology or mental health access points, may reduce disparities in quality of life scores and reduce healthcare costs.