Veterans Administration Medical Center, White River Junction, Vermont 05009, USA.
J Rural Health. 2010 Summer;26(2):156-63. doi: 10.1111/j.1748-0361.2010.00277.x.
Cross-sectional studies have identified rural-urban disparities in veterans' health-related quality-of-life (HRQOL) scores.
To determine whether longitudinal analyses confirmed that these disparities in veterans' HRQOL scores persisted.
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.
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.
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.
横断面研究已经确定了退伍军人健康相关生活质量（HRQOL）评分的城乡差异。
确定纵向分析是否证实退伍军人 HRQOL 评分的这些差异仍然存在。
我们从退伍军人事务部（VA）的医疗保健体验调查（SHEP）的 SF-12 部分获取了数据，该调查是在 2002 年至 2006 年间收集的。在此期间，SHEP 每年随机向大约 250,000 名使用 VA 门诊服务的退伍军人发放。我们评估了在研究期间完成了 2 次或更多次调查的退伍军人的 163,709 次回复。使用基于邮政编码的城乡通勤区指定，将受访者分为城乡群体。我们使用广义估计方程估计线性回归模型，以确定在研究期间，农村和城市退伍军人的 HRQOL 评分是否以不同的速度变化。
在调整了社会人口统计学差异后，我们发现城市退伍军人的身体 HRQOL 评分明显优于农村退伍军人，并且这些差异在研究期间持续存在。虽然城市退伍军人的心理健康评分比农村退伍军人差，但这些差异在研究期间有所减少。
当跟踪退伍军人进行纵向研究时，HRQOL 评分的城乡差异仍然存在。农村退伍军人获得护理的机会减少可能导致这些差异。由于农村士兵在当前冲突中所占比例过高，VA 应考虑新的护理模式，以改善农村退伍军人的护理机会。
