The Impact of Living in Rural and Urban Areas: Vitamin D and Medical Costs in Veterans

Beth A. Bailey PhD1, Todd Manning BA2, Alan N. Peiris MD, PhD 2,3
1 Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee
2 Mountain Home Veterans Administration Medical Center, Mountain Home, Tennessee
3 Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
© 2012 National Rural Health Association
The Journal of Rural Health, Article first published online: 4 APR 2012, DOI: 10.1111/j.1748-0361.2012.00407.x

Purpose: Living in a rural region is associated with significant health disparities and increased medical costs. Vitamin D deficiency, which is increasingly common, is also associated with many adverse health outcomes. The purpose of this study was to determine whether rural-urban residence status of veterans was related to vitamin D levels, and to determine if this factor also influenced medical costs/service utilization. Additionally explored was whether vitamin D differences accounted for part of the association between area of residence and medical costs/service utilization.

Methods: Medical records of 9,396 veterans from 6 Veterans Administration Medical Centers were reviewed for variables of interest including county of residence, vitamin D level, medical costs and service utilization, and background variables. Rurality status was classified as large metropolitan, urban, and rural.

Findings: The 3 rurality status groups differed significantly in vitamin D levels, with the highest levels observed for urban residents, followed by rural residents, and the lowest for large metro residents. Compared with urban residents, large metro residents were 49% more likely, while rural residents were 20% more likely, to be vitamin D deficient. Both rural and large metro residents had higher medical costs, and they were significantly more likely to be hospitalized. Vitamin D levels explained a statistically significant amount of the relationship between rurality status and medical costs/service utilization.

Conclusions: Vitamin D deficiency may be an additional health disparity experienced by both rural and inner-city veterans, and patients residing in these locations should be considered at increased risk for deficiency and routinely tested.
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From Medscape

	ng/ml	Costs for outpatient care	Cost for inpatient care
Urban	29.5	$5455	$20,294
Rural	28.0	$6268	$23,275
Metro	27.5	$7493	$25,057

See also VitaminDWiki

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