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Publication Briefs

Study Suggests Rural-Dwelling VA Patients have Worse Physical Health but Better Mental Health than Urban-Dwelling Counterparts


  • Rural Veterans reported worse physical health but better mental health when compared to their urban counterparts, and these differences persisted across the four survey years. The differences were substantial and statistically significant and persisted after correcting for age, gender, marital and employment status, educational level, and local income level.
  • The differences between rural and urban populations depend on the classification systems used to define the populations: the population classified as “urban” was 40% larger when using VA definitions based on census tract than when using definitions developed by the Health Resources and Service Administration and other Federal agencies, known as RUCA (Rural-Urban Commuting Area). The VA-defined “highly rural” population was less than 20% as large as the RUCA-defined “isolated” population and described a healthier population – in terms of both mental and physical health status.
  • “Rural” and “highly rural” Veterans, as defined by VA, make up 41% of VA healthcare users.

Previous studies have identified rural-urban disparities in Veterans’ health-related quality-of-life (HRQOL) scores; however, the precise relationship between reduced health services access and diminished HRQOL is unclear. This study sought to determine whether these disparities in Veterans’ HRQOL scores persisted over time in longitudinal analyses. Population differences in HRQOL can be measured by Veterans SF-12 scores, which can then be used to determine physical and mental health component scores that reflect overall physical and mental health status, respectively. Investigators analyzed data for 163,709 Veterans who completed the SF-12 portion of VA’s Survey of Healthcare Experiences of Patients (SHEP) between 2002 and 2006. Using ZIP code of residence, Veterans who responded to two or more surveys over the study period were classified into rural/urban groups using two different classification schemes: Rural-Urban Commuting Area (RUCA) designations (urban, rural, isolated) and VA designations (urban, rural, highly rural) estimated from county-level data.


  • Results were limited to Veterans’ self-reporting of functional status.
  • The study did not compare measures of access to or quality of VA care in rural versus urban settings, nor did it determine whether differences in health status were associated with different levels of access to care.
  • The study was limited to Veterans who use the VA healthcare system.


  • Because rural residents have been proportionally over-represented among recent military recruits and account for a high proportion of the casualties in current conflicts, authors suggest that VA administrators and policymakers should anticipate greater healthcare demands from rural veterans and pursue innovative strategies to meet their healthcare needs.

This study was funded by HSR&D. Dr. Wallace and Mr. Lee are part of the VA Outcomes Group at the White River Junction VAMC.

PubMed Logo Wallace A, Lee R, MacKenzie T, et al. A Longitudinal Analysis of Rural and Urban Veterans’ Health-Related Quality of Life. Journal of Rural Health March 2010;26(2):156-63.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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