Health Disparities in Veterans

Kondo, Karli; Low, Allison; Everson, Teresa; Gordon, Christine D; Veazie, Stephanie; Lozier, Crystal C; Freeman, Michele; Motu’apuaka, Makalapua; Mendelson, Aaron; Friesen, Mark; Paynter, Robin; Friesen, Caroline; Anderson, Johanna; Boundy, Erin; Quiñones, Ana; Kansagara, Devan

doi:10.1097/mlr.0000000000000756

Cited by 47 publications

(29 citation statements)

References 3 publications

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“…This report also indicated that overall quality of care varied by geographic region in which a person resided, with some people having lower quality of care based on where they lived [20]. In the US Department of Veterans Affairs (VA), VA patients with mental health conditions and those of lower socioeconomic status had significantly poorer health outcomes than those who did not have mental health conditions or higher socioeconomic status [21]. As a final example of health outcome disparities, in 2013, cardiovascular disease, HIV, and diabetes rates were significantly higher among people of color than white individuals [22].…”

Section: Introductionmentioning

confidence: 99%

The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment

Woodward

Matthieu

Uchendu³

et al. 2019

Implementation Sci

263

259

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BackgroundResearchers could benefit from methodological advancements to advance uptake of new treatments while also reducing healthcare disparities. A comprehensive determinants framework for healthcare disparity implementation challenges is essential to accurately understand an implementation problem and select implementation strategies.MethodsWe integrated and modified two conceptual frameworks—one from implementation science and one from healthcare disparities research to develop the Health Equity Implementation Framework. We applied the Health Equity Implementation Framework to a historical healthcare disparity challenge—hepatitis C virus (HCV) and its treatment among Black patients seeking care in the US Department of Veterans Affairs (VA). A specific implementation assessment at the patient level was needed to understand any barriers to increasing uptake of HCV treatment, independent of cost. We conducted a preliminary study to assess how feasible it was for researchers to use the Health Equity Implementation Framework. We applied the framework to design the qualitative interview guide and interpret results. Using quantitative data to screen potential participants, this preliminary study consisted of semi-structured interviews with a purposively selected sample of Black, rural-dwelling, older adult VA patients (N = 12), living with HCV, from VA medical clinics in the Southern part of the USA.ResultsThe Health Equity Implementation Framework was feasible for implementation researchers. Barriers and facilitators were identified at all levels including the patient, provider (recipients), patient-provider interaction (clinical encounter), characteristics of treatment (innovation), and healthcare system (inner and outer context). Some barriers reflected general implementation issues (e.g., poor care coordination after testing positive for HCV). Other barriers were related to healthcare disparities and likely unique to racial minority patients (e.g., testimonials from Black peers about racial discrimination at VA). We identified several facilitators, including patient enthusiasm to obtain treatment because of its high cure rates, and VA clinics that offset HCV stigma by protecting patient confidentiality.ConclusionThe Health Equity Implementation Framework showcases one way to modify an implementation framework to better assess health equity determinants as well. Researchers may be able to optimize the scientific yield of research inquiries by identifying and addressing factors that promote or impede implementation of novel treatments in addition to eliminating healthcare disparities.Electronic supplementary materialThe online version of this article (10.1186/s13012-019-0861-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment

Woodward

Matthieu

Uchendu³

et al. 2019

Implementation Sci

263

259

View full text Add to dashboard Cite

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“…While research with veterans has identified significant disparities in arthritis pain management and choice of interventions among VHA patients (24,25), less is understood about psychosocial mechanisms of disparities in OA-related health outcomes. Clarifying the links among cumulative disadvantage, perceived discrimination, and health among veterans with OA is particularly important, given the increasing diversity and aging nature of the veteran population, their high risk for declines in health, and ongoing efforts by the VHA to eliminate health disparities (3,26).…”

Section: Introductionmentioning

confidence: 99%

Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination

McClendon

Essien

Youk

et al. 2020

Arthritis Care & Research

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Objective. Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain. Methods. We analyzed baseline data from 270 African American veterans and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at 2 Department of Veterans Affairs medical centers. Participants were age ≥50 years and self-reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self-reported female sex, African American race, annual income of <$20,000, and/or unemployed due to disability). We used linear regression models and Sobel's test of mediation to examine hypotheses. Results. The mean ± SD number of social disadvantages was 1.3 ± 1.0. Cumulative disadvantage was significantly associated with higher perceived discrimination, pain, and depression (P < 0.001 for all). Perceived discrimination significantly mediated the association between cumulative disadvantage and depression symptoms (Z = 3.75, P < 0.001) as well as pain severity (Z = 2.24, P = 0.025). Conclusion. Perceived discrimination is an important psychosocial stressor that contributes to worsening OA-related mental and physical health outcomes, with greater effects among those from multiple socially disadvantaged groups.

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“… 7 8 It is likely that nearly 3 million other veterans have pre-diabetes. These high rates compared with the general population may be due to the increased proportions of overweight (37%) and obesity (41%) among veterans, 9 their older age, lower socioeconomic status 10 and possible exposure to herbicides such as Agent Orange. 11…”

Section: Introductionmentioning

confidence: 99%

US veterans administration diabetes risk (VADR) national cohort: cohort profile

et al. 2020

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PurposeThe veterans administration diabetes risk (VADR) cohort facilitates studies on temporal and geographic patterns of pre-diabetes and diabetes, as well as targeted studies of their predictors. The cohort provides an infrastructure for examination of novel individual and community-level risk factors for diabetes and their consequences among veterans. This cohort also establishes a baseline against which to assess the impact of national or regional strategies to prevent diabetes in veterans.ParticipantsThe VADR cohort includes all 6 082 018 veterans in the USA enrolled in the veteran administration (VA) for primary care who were diabetes-free as of 1 January 2008 and who had at least two diabetes-free visits to a VA primary care service at least 30 days apart within any 5-year period since 1 January 2003, or veterans subsequently enrolled and were diabetes-free at cohort entry through 31 December 2016. Cohort subjects were followed from the date of cohort entry until censure defined as date of incident diabetes, loss to follow-up of 2 years, death or until 31 December 2018.Findings to dateThe incidence rate of type 2 diabetes in this cohort of over 6 million veterans followed for a median of 5.5 years (over 35 million person-years (PY)) was 26 per 1000 PY. During the study period, 8.5% of the cohort were lost to follow-up and 17.7% died. Many demographic, comorbidity and other clinical variables were more prevalent among patients with incident diabetes.Future plansThis cohort will be used to study community-level risk factors for diabetes, such as attributes of the food environment and neighbourhood socioeconomic status via geospatial linkage to residence address information.

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Health Disparities in Veterans

Abstract: Our evidence maps provide a "lay of the land" and identify important gaps in knowledge about health disparities experienced by different Veteran populations.

Cited by 47 publications

References 3 publications

The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment

The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment

Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination

US veterans administration diabetes risk (VADR) national cohort: cohort profile

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