Chronic Lower Limb Wound Outcomes Among Rural And Urban Veterans

ASU Author/Contributor (non-ASU co-authors, if there are any, appear on document)
Erin Bouldin, Assistant Professor, PhD (Creator)
Appalachian State University (ASU )
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Abstract: Purpose: Veterans in rural areas generally have lower health care utilization than veterans in urban areas but the impact of this difference on health outcomes has received little study. Chronic wounds provide a model for studying access to complex chronic care since they often are related to underlying health conditions and require lengthy treatment. Our goals were to describe chronic wound care utilization among rural and urban veterans and to determine the association between rural residence and wound healing. Methods: We conducted a retrospective cohort study of 160 rural and 160 urban veterans in the Pacific Northwest with an incident chronic lower limb wound between October 1, 2006 and September 30, 2007. We followed individuals for up to one year, measuring wound care utilization within VHA and Medicare. We compared wound healing using a competing risks proportional hazards model accounting for amputation and death. Findings: Rural veterans had fewer outpatient wound care visits (6.8 versus 9.9) than urban veterans and a similar number of inpatient wound care stays (0.9 and 0.8, respectively). During follow-up, 234 veterans’ wounds healed (77% rural, 69% urban). The adjusted hazard ratio for wound healing was 1.11 (95% CI: 0.84-1.47, p=0.45) for rural compared to urban veterans. The hazard of amputation was higher among rural veterans (HR=2.65, 95% CI: 1.02-6.87, p=0.045) and the hazard of death was lower (HR=0.35, 95% CI: 0.12-0.97, p=0.043). Conclusions: Despite lower wound care utilization, rural veterans’ wounds were as likely to heal as urban veterans’ wounds.

Additional Information

Bouldin, E., Taylor, L., Littman, A., Karavan, M., Rice, K., Reiber, G. (2015). Chronic Lower Limb Wound Outcomes Among Rural And Urban Veterans. The Journal of Rural Health; 31(4):410-20. Version of record available at:
Language: English
Date: 2015
ulcer, lower limb, veterans, rural health, utilization

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