Premium
Chronic Lower Limb Wound Outcomes Among Rural and Urban Veterans
Author(s) -
Bouldin Erin D.,
Taylor Leslie L.,
Littman Alyson J.,
Karavan Mahsa,
Rice Kenneth,
Reiber Gayle E.
Publication year - 2015
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/jrh.12115
Subject(s) - medicine , hazard ratio , veterans affairs , amputation , chronic wound , wound care , proportional hazards model , health care , retrospective cohort study , rural area , confidence interval , emergency medicine , gerontology , environmental health , wound healing , intensive care medicine , surgery , pathology , economics , economic growth
Purpose Veterans in rural areas generally have lower health care utilization than veterans in urban areas, but the impact of this difference on health outcomes has received little study. Chronic wounds provide a model for studying access to complex chronic care since they often are related to underlying health conditions and require lengthy treatment. Our goals were to describe chronic wound care utilization among rural and urban veterans and to determine the association between rural residence and wound healing. Methods We conducted a retrospective cohort study of 160 rural and 160 urban veterans in the Pacific Northwest with an incident of chronic lower limb wound between October 1, 2006, and September 30, 2007. We followed individuals for up to 1 year, measuring wound care utilization within Veterans Health Administration and Medicare. We compared wound healing using a competing risks proportional hazards model accounting for amputation and death. Findings Rural veterans had fewer outpatient wound care visits (6.8 vs 9.9) than urban veterans and a similar number of inpatient wound care stays (0.9 and 0.8, respectively). During follow‐up, 234 veterans’ wounds healed (77% rural, 69% urban). The adjusted hazard ratio for wound healing was 1.11 (95% confidence intervals [CI]: 0.84‐1.47, P = .45) for rural compared to urban veterans. The hazard of amputation was higher among rural veterans (hazard ratio [HR] = 2.65, 95% CI: 1.02‐6.87, P = .045) and the hazard of death was lower (HR = 0.35, 95% CI: 0.12‐0.97, P = .043). Conclusions Despite lower wound care utilization, rural veterans’ wounds were as likely to heal as urban veterans’ wounds.