Differences in health-related quality of life in rural and urban veterans

Abstract

Objectives: We sought to determine whether disparities in health-related quality of life exist between veterans who live in rural settings and their suburban or urban counterparts.

Methods: We determined health-related quality-of-life scores (physical and mental health component summaries) for 767109 veterans who had used Veterans Health Administration services within the past 3 years. We used rural/urban commuting area codes to categorize veterans into rural, suburban, or urban residence.

Results: Health-related quality-of-life scores were significantly lower for veterans who lived in rural settings than for those who lived in suburban or urban settings. Rural veterans had significantly more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts. Rural-urban disparities persisted in all survey subscales, across regional delivery networks, and after we controlled for sociodemographic factors.

Conclusions: When compared with their urban and suburban counterparts, veterans who live in a rural setting have worse health-related quality-of-life scores. Policymakers, within and outside the Veterans Health Administration, should anticipate greater health care demands from rural populations.

FIGURE 1—

Unadjusted health-related quality-of-life scores, by veterans’ urban/suburban/ rural residence, compared with the general US population scores of 50 for both physical and mental health; a lower score indicates a worse health-related quality of life. Note. Differences between groups are statistically significant at P < .001. Differences of 2.5 points are considered clinically meaningful.

FIGURE 2—

Urban and rural physical health component summary scores for each veterans integrated service network, arranged by descending urban score and compared with the general US population scores of 50 for both physical and mental health. Note. The locations of each network headquarters are shown.

FIGURE 3—

Urban and rural mental health component summary scores for each Veterans Integrated Service Network, arranged by descending urban score and compared with the general US population scores of 50 for both physical and mental health. Note. The locations of each network headquarters are shown.