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Impact of Rural Residence on Survival of Male Veterans Affairs Patients After Age 65
Author(s) -
MacKenzie Todd A.,
Wallace Amy E.,
Weeks William B.
Publication year - 2010
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/j.1748-0361.2010.00300.x
Subject(s) - residence , medicine , marital status , demography , socioeconomic status , rural area , gerontology , veterans affairs , environmental health , population , pathology , sociology
Objectives: More than 1 in 5 Veterans Affairs (VA) users lives in a rural setting. Rural veterans face different barriers to health care than their urban counterparts, but their risk of death relative to their urban counterparts is unknown. The objective of our study was to compare survival between rural and urban VA users. Methods: We linked the Large Health Survey of Veteran Enrollees conducted in 1999 to the Veterans Administration vital status registry. We used time‐to‐event regression models controlling for patient race, education, ZIP‐code median income, and marital and smoking status. Findings: Of the 372,463 male veterans of age 65 or greater, 80,931 lived in rural settings. Age‐adjusted mortality was 5.9% higher (95% CI, 4.5%‐7.2%) in rural residents compared to urban residents. After adjusting for age, education, and ZIP‐code median income, rural residents had 3.0% lower mortality (95% CI, 1.5%‐4.4%). Compared to urban and suburban VA users, rural VA users’ mortality at age 65 was 12% lower, but this advantage gradually diminished by age 75. Conclusion: Mortality after the age of 65 for male VA users is higher in rural dwellers than in urban dwellers. However, among veterans of the same socioeconomic characteristics, rural‐dwelling veterans have up to 15% better mortality than urban‐dwelling veterans until the age of 75.