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A study of more than 767,000 veterans by Veterans Affairs and Dartmouth Medical School researchers shows those in rural areas are in poorer health than their urban counterparts.
The findings, reported in the October American Journal of Public Health, validate recent and ongoing VA efforts to expand health care for rural patients, according to the researchers.
"We need to think about veterans who live in rural settings as a special population, and we need to carefully consider their needs when designing health-care delivery systems," said team leader William Weeks, Associate Professor of Psychiatry and of Community and Family Medicine and researcher with the White River Junction VA Outcomes Group.
This is the first nationwide comparison of the health status of rural versus urban VA patients. The researchers used a questionnaire that measures eight areas of physical and mental health. The average physical health score among rural veterans was around 33, compared to 37 for urban veterans. The disparity was somewhat less marked in mental health: rural veterans scored 44.5, compared to 45.6 for urban veterans. The average score for all U.S. adults, young and old, is 50 for both the physical and mental components. Veterans tend to be in worse health than the general U.S. population, partly because on average they are older. The average age of VA patients in the study was 63.
The finding that rural veterans are in poorer health persisted even after researchers adjusted for socioeconomic factors that may tend to be different among rural and urban veterans, such as race, education or employment status. The results "validate that better access to care is needed in rural settings," Weeks said.
The research included 767,109 veterans who had used VA healthcare between 1996 and 1999, when VA began setting up Community Based Outpatient Clinics (CBOCs) to provide primary care closer to home for rural veterans. Today there are nearly 700 CBOCs in VA's nationwide system, and recent recommendations call for the establishment of more than 150 additional CBOCs.
This study was funded by the Veterans Rural Health Care Initiative, White River Junction, VAMC and by the VA Outcomes Group Research, Health Services Research and Development. Co-authors are from Boston University and the VA Bedford, Mass., and the Department of Veterans Affairs, Washington, D.C.
For more information see www.dartmouth.edu/dms/news.
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