Longitudinal differences in health status and utilization when comparing rural to urban veterans

Background Using cross-sectional 1999 data, we have demonstrated that veterans living in rural settings have worse health-related quality-of-life than their urban counterparts. Since then, the number of both VA access points and enrollees has increased substantially. In light of these changes, we wanted to determine whether rural/urban disparities in health-related quality-of-life persist and whether trends in health-related quality-of-life scores were different when comparing rural and urban veterans. Finally, with an interest in anticipating the alignment of health care needs and resources for returning veterans, we wanted to determine whether service utilization for rural and urban veterans was different.

Methods We obtained data from the VA's Survey of Healthcare Experiences of Patients collected between 2002 and 2006. That survey is administered to approximately 200,000 randomly selected VA users each year and includes the SF-12. We used Rural-Urban Commuting Area codes to determine whether respondents lived in rural or urban settings. For each year, we compared raw and demographic adjusted mental (MCS) and physical health (PCS) component scores for rural and urban veterans. By chance, 7,668 rural dwelling and 6,514 urban dwelling patients were surveyed at least three times between 2002 and 2006; for those cohorts, we determined whether time series trends in health-related quality-of-life scores differed when comparing rural and urban veterans.

Results For every year examined, rural veterans reported worse unadjusted and adjusted health-related quality-of-life than their urban counterparts. Rural veterans' unadjusted PCS scores were 1.6 points lower than their urban counterparts'; adjusted PCS scores were 0.43 points lower (p<0.001 for all). Differences in MCS scores were not significant. We found no statistical differences in the trends in health-related quality-of-life scores in the longitudinal cohort, although rural veterans' MCS scores declined somewhat faster than did urban veterans' (-0.41 vs. -0.26 points per year, p=0.07). Rural veterans used significantly less inpatient care.

Discussion Rural veterans have worse health-related quality-of-life than their urban counterparts, and living in a rural setting is an independent contributor to worse health status. Rural veterans to consume fewer inpatient resources than their urban counterparts; however, with the exception of a trend toward a faster decline in mental health-related quality-of-life, this lower consumption level appears to have no consequences. These findings suggest that the additional resources that urban dwelling veterans consume do not substantially improve their health-related quality-of-life. Therefore, redirecting healthcare resources to facilities that serve rural veterans should not compromise the health status of urban veteran populations.