Key result
Rural residence linked to ~20% higher 30-day mortality but lower readmission risk versus urban residence.
Why the study?
Evidence suggests rural-residing adults may have different risks of readmission and mortality compared with urban adults, but effects in older Veterans discharged from VA hospitals were unclear.
Does rural residence affect the risk of unplanned readmission and mortality in older Veterans discharged from VA hospitals?
Cohort (n=99,557)
Yes
Does rural residence affect the risk of unplanned readmission and mortality in older Veterans discharged from VA hospitals?
Older Veterans residing in rural areas have a lower risk of 30-day readmission but a higher risk of mortality compared to urban residents after hospital discharge.
Answers are grounded in this paper and cite their sources.
Rural residence may raise readmission or mortality risk in older VA Veterans; leaves open targeted post-discharge interventions.
PURPOSE: Evidence suggests that rural-residing adults-compared with urban-may be at greater risk of readmission and mortality. Operational leaders within the Department of Veterans Affairs (VA) Geriatric Learning Health System (GLHS) sought to understand the effects of rural residence on readmission and mortality risk for older Veterans discharged from hospital to home. METHODS: This observational cohort study included Veterans aged ≥ 65 years discharged from VA hospitals (fiscal year 2023) to home. A semi-competing risk model was fit to jointly model unplanned readmission, mortality, and mortality after readmission, with rural residence as the exposure of interest. Data were censored at 30-days, 90-days, or 1-year post discharge to examine short- and longer-term effects. Additional variables considered for the model were identified through prior literature, clinical significance and those selected by the Centers for Medicare & Medicaid Services for unplanned readmission. FINDINGS: Among 99,557 patients (120 hospitals), 28.4% were rural residents. Only 18% of rural residents lived within 30 min of a VA facility versus 80.3% of urban residents. At 30 days, compared to urban, rural-residing patients had a 5% lower risk of readmission (hazard ratio [HR] = 0.95, 95% confidence interval [CI] = [0.91-1.00]), 20% higher risk of mortality (HR = 1.20, 95% CI = [1.03-1.40]), and a similarly higher risk of mortality after readmission (HR = 1.19, 95% CI = [1.03-1.39]). CONCLUSION: Rural-residing older Veterans had lower risk of readmission but higher risk of mortality. These findings will guide future VA GLHSs: seeking modifiable factors (e.g., social drivers of health, timely services) associated with mortality risk among rural Veterans that can inform practice, policy, and quality improvement, thereby reducing disparities in outcomes.
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Daggy et al. (2026) conducted a cohort in Discharged from hospital to home (n=99,557). Rural residence vs. Urban residence was evaluated on Unplanned readmission at 30 days (HR 0.95, 95% CI 0.91-1.00). Rural residence was associated with a lower risk of 30-day readmission (HR 0.95; 95% CI 0.91-1.00) but a higher risk of 30-day mortality (HR 1.20; 95% CI 1.03-1.40) compared to urban residence.
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