Examining Rurality Status In Veterans Enrolled In Lifestyle Intervention Programming In The Veterans Health Administration

PURPOSE: To examine associations between rurality status and utilization of lifestyle programming in Veterans using the Veterans Health Administration (VHA). METHODS: Veterans in fiscal year (FY) 2023 (September 2022-October 1, 2023) were identified using VA electronic medical record data. Veterans were then categorized into two groups: rural and urban. Rurality status was determined by using Veteran’s home address, leveraging the Rural-Urban Commuting Area Codes. Clinical stop codes were used to classify Veterans into lifestyle programs: complementary and integrative health (CIH) services, wellbeing services, nutrition/dietetics, recreation therapy, geriatrics, and weight management services. Sociodemographic characteristics: age, gender, and race and ethnicity, were collected. Logistic regression was performed on lifestyle programs by rurality status. Statistical significance was alpha of 0.05. All analyses were conducted in R Studio Version 4.2. RESULTS: 307,968 Veterans utilized lifestyle programming across the VHA in FY 2023. 72% of Veterans lived in urban areas. Compared to urban Veterans, rural Veterans were less likely to be female (24% and 27%, respectively) and a racial/ethnic minority (all p < 0.001). Rural Veterans were more likely to use CIH services (odds ratio [OR]: 1.05, 95% CI: 1.02, 1.08, p = 0.001), wellbeing services (OR: 1.03, 95% CI: 1.01, 1.05, p = 0.01), group nutrition/dietetics (OR: 1.11, 95% CI: 1.06, 1.16, p < 0.001), individual (OR: 1.16, 95% CI: 1.13, 1.20, p < 0.001) and group (OR: 1.03, 95% CI: 1.01, 1.06, p = 0.02) weight management services, compared to urban Veterans. Further, rural Veterans were less likely use individual nutrition/dietetics (OR: 0.92, 95% CI: 0.90, 0.94, p < 0.001), recreation therapy (OR: 0.85, 95% CI: 0.83, 0.87, p < 0.001), and geriatrics (OR: 0.97, 95% CI: 0.95, 1.00, p = 0.03), compared to urban Veterans. CONCLUSIONS: Rural Veterans were more likely to use CIH, wellbeing, group nutrition/dietetics, and weight management services provided by VHA than Veterans residing in urban areas. But rural Veterans were least likely to participate in recreation therapy, relative to their urban peers. These findings may inform VHA program staff and policymakers to better understand and address how Veteran geography may impact the use of lifestyle interventions.