ArticleJournal of the American Geriatrics Society2026
Rural-Urban Variability in Home and Community-Based Service Use Among Veterans.
Article in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Rural-Urban Variability in Home and Community-Based Service Use Among Veterans.Journal of the American Geriatrics Society · 2026Article
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Authors and funding
13 authors.
Funding
Abstract
backgroundHome and community-based services (HCBS) are home-based services that enable people to remain in their own environment despite challenges related to disease, disability, or age. In rural areas, service availability may be lower. The purpose of this analysis was to examine rural-urban differences in HCBS use among Veterans enrolled in the Veterans Health Administration (VHA) and identify facility-level variation.
methodsThis cross-sectional study used data from fiscal year 2022 (10/1/21-9/30/22). We incorporated rurality for Veterans (dichotomized as rural/urban based on Rural-Urban Area Commuting Codes) and facilities (proportion of rural Veterans served). VHA payment files identified HCBS use. Regression analyses sequentially adjusted for demographics, comorbidity, Area Deprivation Index (ADI), and facility fixed effects to produce a risk ratio (RR) of HCBS use among rural Veterans (RR > 1.0 indicates higher HCBS use among rural vs. urban Veterans).
resultsOf over 6 million enrolled Veterans, 34.1% (n = 2,055,746) were identified as rural. Compared to urban Veterans, rural Veterans were more likely to be older (64.1 ± 16.1 vs. 61.0 ± 17.4 years, p < 0.001), male (92.0% vs. 88.8%, p < 0.001), and white (80.5% vs. 63.7%, p < 0.001). HCBS were used by 5.04% (n = 103,605) of rural Veterans and 5.21% (n = 206,608) of urban Veterans. The unadjusted rural HCBS RR was 0.97 (95% confidence interval (CI) = 0.96-0.97). After adjusting for demographics, comorbidity, ADI, and facility fixed effects, the adjusted RR of HCBS for rural Veterans was 0.92 (95% CI = 0.91-0.93). There was substantial variability across facilities, with rural Veterans ranging from 60% less likely to 167% more likely to use HCBS than urban Veterans (RRs: 0.40-2.67).
conclusionWhile rural Veterans were less likely to use HCBS overall, there was substantial variability across facilities. These findings demonstrate that some VAMCs counteract the overall trend by ensuring rural Veterans receive HCBS at rates comparable to urban Veterans.
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