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

Abstract

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.

Impact of high latitude, urban living and ethnicity on 25-hydroxyvitamin D status: A need for multidisciplinary action?

“…One study of over Mexican children found higher 25 [28]. Indeed, all areas had an average 25(OH)D concentration of 28-30nmol/L [28]. Similarly, in an Indian study [29] and a study in the United Kingdom (UK) [30], no difference in 25(OH)D concentrations between residents of urban or rural areas was identified.…”

“…One study of over Mexican children found higher 25 [28]. Indeed, all areas had an average 25(OH)D concentration of 28-30nmol/L [28].…”

Low serum vitamin D-status, air pollution and obesity: A dangerous liaison

“…As the skin synthesis of vitamin D, which occurs through the action of sunlight, is not surprising that a reduced radiation caused by air pollution constitutes one of the main causes of vitamin D deficiency [4]. Accordingly, urban residents, especially in areas with high levels of ambient air pollution, tend to be less engaged in outdoor activities and have a higher prevalence of D hypovitaminosis compared to rural inhabitants [7]. …”

High-Prevalence Vitamin D Deficiency among Korean Emergency Department Homeless, with a Comparison to a Healthy Korean Population

“…In fact, urban residence itself might be a major determinant of vitamin D status among the homeless. However, American studies have shown better vitamin D status for urban residents than for rural residents [24,25]. Other behavior and cultural factors, not evaluated in this study, could also affect vitamin D status.…”