Sleep disorders among rural Veterans: Relative prevalence, comorbidities, and comparisons with urban Veterans

Purpose: To describe and compare demographic characteristics and comorbidities of rural and urban Veterans diagnosed with sleep disorders, and to evaluate whether rurality is a disparity for sleep care among Veterans. Methods: Numbers of Veterans with sleep disorders and comorbid conditions were determined using the Department of Veterans Affairs (VA's) Corporate Data Warehouse, a database that contains detailed clinical information for all Veterans who receive VA health care. Comparisons between urban and rural Veterans were conducted for fiscal years (FY) 2010-2021. Findings: The prevalence of diagnosed sleep disorders was similar among rural and urban Veterans from FY2010 to 2021 and increased for both groups during this time period. The prevalence of chronic pulmonary disease, congestive heart failure, and diabetes mellitus was higher for rural Veterans with sleep disorders compared to their urban counterparts. From 2012 to 2021, the percentage of rural Veterans who received sleep care at VA facilities was lower than the percentage of urban Veterans who received VA sleep care during the same time span. Conclusions: Although rural Veterans exhibited a higher prevalence of 3 comorbid conditions associated with sleep disorders, the prevalence of sleep disorder diagnoses was similar between rural and urban Veterans. Therefore, it is possible that sleep disorders are underdiagnosed among rural Veterans. The fact that rural Veterans received VA sleep care at a lower rate compared to urban Veterans indicates that rurality is a disparity in access to care in this population. VA is addressing this disparity through a variety of programs, including telehealth initiatives.