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William B. Weeks, MD, MBA, Lewis E. Kazis, ScD, Yujing Shen, PhD, Zhongxiao Cong, MA, MS, Xinhua S. Ren, PhD, Donald Miller, ScD, Austin Lee, PhD and Jonathan B. Perlin, MD, PhD

William B. Weeks is with the departments of Psychiatry and of Community and Family Medicine, Dartmouth Medical School, Hanover, NH; Veterans Administration’s National Center for Patient Safety, White River Junction, NH; Veterans Administration Outcomes Group, White River Junction; and Veterans’ Rural Health Initiative, White River Junction. At the time of the study, Yujing Shen and Zhongxiao Cong were with, and Lewis E. Kazis, Xinhua S. Ren, Donald Miller, and Austin Lee are with, the Center for Health Quality Outcomes and Economic Research, Veterans Administration, Bedford, Mass. Lewis E. Kazis, Xinhua S. Ren, and Donald Miller are also with, and Yujing Shen and Zhongxiao Cong were with, the Boston University School of Public Health, Boston, Mass. Austin Lee is also with the Department of Actuarial Science, Boston University, Boston, Mass. Jonathan B. Perlin is with the Department of Veterans Affairs, Washington, DC.

Correspondence: Requests for reprints should be sent to William B. Weeks, MD, MBA, White River Junction, VT 05009 (e-mail: wbw{at}dartmouth.edu).

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.

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