title: A longitudinal analysis of rural and urban veterans' health-related quality of life.
abstract: BACKGROUND
  Cross-sectional studies have identified rural-urban disparities in veterans' health-related quality-of-life (HRQOL) scores.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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.
authors.affiliation: Veterans Administration Medical Center, White River Junction, Vermont 05009, USA. aew@dartmouth.edu
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wallace
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Todd A
authors.initials: TA
authors.lastname: Mackenzie
authors.forename: Alan N
authors.initials: AN
authors.lastname: West
authors.forename: Steven
authors.initials: S
authors.lastname: Wright
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
authors.forename: Kara
authors.initials: K
authors.lastname: Hawthorne
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011788:Quality of Life; D012424:Rural Population; D011795:Surveys and Questionnaires; D014481:United States; D014505:Urban Population; D014728:Veterans