A Longitudinal Analysis of Rural and Urban Veterans’ Health-Related Quality of Life

Authors

  • Amy E. Wallace MD, MPH,

    1. Veterans Administration Medical Center, White River Junction, Vermont
    2. Veterans’ Rural Health Resource Center—Eastern Region, White River Junction, Vermont
    3. Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire
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  • Richard Lee MPH,

    1. Veterans Administration Medical Center, White River Junction, Vermont
    2. Veterans’ Rural Health Resource Center—Eastern Region, White River Junction, Vermont
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  • Todd A. MacKenzie PhD,

    1. Veterans Administration Medical Center, White River Junction, Vermont
    2. Veterans’ Rural Health Resource Center—Eastern Region, White River Junction, Vermont
    3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
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  • Alan N. West PhD,

    1. Veterans Administration Medical Center, White River Junction, Vermont
    2. Veterans’ Rural Health Resource Center—Eastern Region, White River Junction, Vermont
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  • Steven Wright PhD,

    1. Office of Quality and Performance, Veterans Health Administration, Washington, DC
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  • Brenda M. Booth PhD,

    1. University of Arkansas for Medical Sciences, Little Rock, Arkansas
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  • Kara Hawthorne MSW,

    1. Office of Rural Health, Veterans Health Administration, Washington, DC
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  • William B. Weeks MD, MBA

    1. Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire
    2. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
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  • The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (project REA 03-098) and VA's Office of Rural Health. The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States government. For further information, contact: Amy E. Wallace, MD, MPH, VAMC (151), 215 North Main Street, White River Junction, VT 05009; e-mail aew@dartmouth.edu.

Abstract

Context: Cross-sectional studies have identified rural-urban disparities in veterans’ health-related quality-of-life (HRQOL) scores.

Purpose: To determine whether longitudinal analyses confirmed that these disparities in veterans’ HRQOL scores persisted.

Methods: We obtained data from the SF-12 portion of the veterans health administration's (VA's) Survey of Healthcare Experiences of Patients (SHEP) collected between 2002 and 2006. During that time, the SHEP was randomly administered to approximately 250,000 veterans annually who had used VA outpatient services. We evaluated 163,709 responses from veterans who had completed 2 or more surveys during the years studied. Respondents were classified into rural-urban groups using ZIP Code-based rural-urban commuting area designations. We estimated linear regression models using generalized estimating equations to determine whether rural and urban veterans’ HRQOL scores were changing at different rates over the time period examined.

Findings: After adjustment for sociodemographic differences, we found that urban veterans had substantially better physical HRQOL scores than their rural counterparts and that these differences persisted over the study period. While urban veterans had worse mental HRQOL scores than rural veterans, those differences diminished over the time period studied.

Conclusions: Rural-urban disparities in HRQOL scores persist when tracking veterans longitudinally. Reduced access among rural veterans to care may contribute to these disparities. Because rural soldiers are overrepresented in current conflicts, the VA should consider new models of care delivery to improve access to care for rural veterans.

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