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Comparative Study
. 2012 Spring;28(2):211-20.
doi: 10.1111/j.1748-0361.2011.00380.x. Epub 2011 May 25.

Echocardiogram utilization among rural and urban veterans

Kingston Okrah  1 , Mary Vaughan-Sarrazin, Peter Kaboli, Peter Cram
Affiliations
Comparative Study

Echocardiogram utilization among rural and urban veterans

Kingston Okrah et al. J Rural Health. 2012 Spring.

Abstract

Purpose: To compare echocardiography use among urban and rural veterans and whether differences could be accounted for by distance.

Methods: We used Veterans Administration (VA) administrative data from 1999 to 2007 to identify regular users of the VA Healthcare System (VA users) who did and did not receive echocardiography. Each veteran was categorized as residing in urban, rural or highly rural areas using RUCA codes. Poisson regression was used to compare echocardiography utilization rates among veterans residing in each area after adjusting for demographics, comorbidities, clustering of patients within VA networks and distance to the nearest VA medical center offering echocardiography.

Findings: Our study included 22.7 million veterans of whom 1.3 million (5.7%) received at least 1 echocardiogram. Of echocardiography recipients, 69.2% lived in urban, 22.0% in rural and 8.8% in highly rural areas. In analyses adjusting for patient demographics, comorbidities, and clustering, utilization of echocardiography was modestly lower for highly rural and rural veterans compared with urban veterans (42.0 vs 40.1 vs 43.1 echocardiograms per 1,000 VA users per year for highly rural, rural and urban, respectively; P< .001). After further adjusting for distance, echocardiography utilization was somewhat higher for veterans in highly rural and rural areas than it was for urban areas (44.9 vs 41.8 vs 40.8 for highly rural, rural and urban, respectively; P< .001).

Conclusions: Echocardiography utilization among rural and highly rural veterans was marginally lower than for urban veterans, but these differences can be accounted for by the greater distance of more rural veterans from facilities offering echocardiograms.

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Figures

Figure 1
Figure 1
Trends in unadjusted echocardiography utilization rates for VA users residing in urban, rural and highly rural areas from 1999 to 2007
Figure 2
Figure 2
Trends in adjusted* echocardiography utilization rates for VA users residing in urban, rural and highly rural areas from 1999 to 2007. *Model adjusted for age, race, sex, VISN and comorbid conditions
Figure 3
Figure 3
Trends in adjusted* echocardiography utilization rates for VA users residing in urban, rural and highly rural areas from 1999 to 2007. *Model adjusted for age, race, sex, VISN, comorbid conditions and distance to nearest VAMC
Figure 4
Figure 4
Echocardiography utilization for rural and highly rural veterans living at different distances from nearest VAMC.
See this image and copyright information in PMC

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References

    1. U.S. Department of Transportation. [Accessed May 6, 2010];Census 2000 Population Statistics: U.S. Population Living in Urban vs. Rural Areas. Available at: http://www.fhwa.dot.gov/planning/census/cps2k.htm.
    1. U.S. Census Bureau. [Accessed May 6, 2010];Urban/Rural and Metropolitan/Nonmetropilitan Population. 2000 Available at: http://factfinder.census.gov/servlet/GCTTable?.
    1. Pearson TA, Lewis C. Rural epidemiology: insights from a rural population laboratory. Am J Epidemiol. 1998;148:949–957. - PubMed
    1. Ruland S, Gorelick PB, Schneck M, Kim D, Moore CG, Leurgans S. Acute stroke care in Illinois: a statewide assessment of diagnostic and treatment capabilities. Stroke. 2002;33:1334–1339. - PubMed
    1. Federal Register. Medicare rural hospital flexibility program regulations. Washington, DC: U S Government Printing Office; 1997.

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