Rural-urban disparities in health-related quality of life within disease categories of Veterans.
BACKGROUND
Compared to their urban counterparts, rural veterans have been found to have lower health-related quality of life.


OBJECTIVE
To determine whether these disparities persist when examining disease categories of rural and urban veterans.


METHODS
We obtained survey data on 748,216 veterans who were current or anticipated Veterans Health Administration patients. Using International Classification of Diseases (ICD)-9CM codes, we determined whether these veterans had diagnoses that fell into any of 30 physical health disease categories, and we used ZIP codes to determine whether veterans lived in rural or urban settings. We compared rural to urban prevalence of disease categories as well as urban to rural health-related quality-of-life physical health component summary scores (PCS) and mental health component summary scores (MCS) for each disease category.


RESULTS
Physical diagnoses were significantly more prevalent in the rural veteran population for most disease categories examined. For every disease category examined, PCS were significantly lower for veterans who lived in rural, compared to urban, settings (P < .001 for all); rural veterans also experienced lower MCS for all disease categories although differences were modest. Differences persisted after controlling for sociodemographic factors.


CONCLUSIONS
Compared to the urban veteran population, within disease categories, the rural veteran population experiences higher disease prevalence and lower physical and mental quality-of-life scores. Policymakers should anticipate greater health care demands from the rural veteran population and work to meet that demand.
Weeks
William B
WB
VA Outcomes Group Research Enhancement Award Program, White River Junction, Vt., USA. wbw@dartmouth.edu
Wallace
Amy E
AE
Wang
Stanley
S
Lee
Austin
A
Kazis
Lewis E
LE
D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D012423:Rural Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014504:Urban Health / Q000706:statistics & numerical data*