Vision loss in older veterans is greater in rural than urban areas
Keywords:veteran, veterans, aging, old, older, rural, urban, vision, vision loss, low vision, veterans health administration, va, BRFSS, race, ethnicity, income, msa, generalized linear mixed model, logit link, odds ratio, adjusted odds ratio, aor
Purpose: Although rurality has been shown to be a risk factor for vision loss in the general population, there are no published studies to evaluate the relative risk of vision loss in older veterans (age greater than 64 years). Given that veterans have access to a separate healthcare system, the Veterans Health Administration system, this study sought to determine whether older rural veterans had a higher prevalence of vision loss than older urban veterans.
Methods: Data for this cross-sectional study were obtained from the 2016-2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Older veteran (n = 49,697) self-reported vision loss was regressed on rural-urban area of residence in a mixed logit model, where state of residence served as a random intercept. This study model controlled for age, race, sex, income, binge drinking behavior, cigarette use, BMI, exercise, diabetes, and mental distress.
Results: Analysis demonstrated that vision loss among older veterans was more prevalent in rural areas (6.73%, 95% CI = 6.27, 7.22) than in urban areas (5.89%, 95% CI = 5.57, 6.23). After controlling for all confounders previously described, rurality was independently associated with vision loss among older veterans (aOR = 1.12, 95% CI = 1.02, 1.23).
Conclusions: In a search of the peer-reviewed medical literature (using MEDLINE and cross-referenced literature, this study is the first to demonstrate a rural-to-urban disparity in vision loss among older veterans in the United States. The results of this study demonstrate the need for broader access to health care, including evidence-based remote or telehealth eye care screening and rehabilitation programs for rural veterans, especially within the Veterans Health Administration system.
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