Where do rural and highly rural veterans live?

Adapted for web production by VJ Periyakoil, MD from West A, PhD, Veterans Rural Health Resource Center—Eastern Region: A ZIP Code Crosswalk for Applying Urban, Rural, and Highly Rural Classification.

VA’s three-category classification system

The VA has adopted a three-category system for designating locations across the nation, and their residents, as follows:

  1. Urban: Urban residents include anyone living in a US Census defined urbanized area.
  2. Rural: Rural residents include anyone not defined as Urban.
  3. Highly Rural: Rural residents living in counties with average population density of fewer than 7 civilians per square mile; they represent between 1% and 2% of all VA enrollees.

The VA’s Planning Systems Support Group (PSSG) has assigned each VA enrollee 
an Urban, Rural, or Highly Rural (U/R/HR) designation based on its “geo-coding” of 
the street addresses for their residences, using the resulting latitudes and longitudes to classify them.

In addition to U/R/HR designations, this system also include each enrolled veteran’s travel times from their primary address to reach the nearest VA facilities that provide primary, acute, and tertiary care.

The ZIP Code Crosswalk System for categorization of urban, rural and highly rural veterans

The VA system enrollment files can be linked to either Patient Treatment File data or VA-Medicaredata. It is possible to compare Urban, Rural, and Highly Rural enrollees on their use of VA and Medicare treatment.

  • Relevant analyses may require using other non-VA healthcare data, as well, such as the UB92 administrative data that many states collect.
  • Such data cannot be linked to individual VA enrollees, or may include individuals other than VA enrollees, and are very unlikely to have been geo-coded, or even to include home addresses that could be geo-coded.
  • Nevertheless, ZIP codes for patients’ residences often are recorded.
  • To perform comparative studies with these data, each ZIP code would have to be assigned a U/R/HR designation.
  • For this purpose, the Office of Rural Health asked the Veterans Rural Health Resource Center—Eastern Region to develop a ZIP code crosswalk to the U/R/HR system.

Challenges in building the ZIP code cross walk

  • Some ZIP codes represent substantial areas that may include urban, rural, and/or highly rural locales under the same ZIP; this leads to inaccuracies.
  • Due to population shifts, the ZIP code cross walk needs to be updated periodically.

Creating a single ZIP code crosswalk table of enrolled vets

The designations for the two years to create a single crosswalk as follows:

  1. If a ZIP code has a U/R/HR designation in the 2007 data, it was assigned the same designation to the crosswalk, even if it differs from the 2006 designation
    (a rare occurrence).
  2. If any other ZIP has a designation in the 2006 data, but is missing in the 2007 data, it was assigned its 2006 designation to the crosswalk. In other words, all the U/R/HR designations that could be derived from the 2007 data was included and any additional ZIPs that appeared in the 2006 data was added.
  3. Assuming the PSSG designations as the gold standard, the error related to potential misclassification of enrolled veterans was also estimated as shown
    in Table 3.

Tables and Data

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