Women Veterans’ Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care

Mattocks, Kristin M.; Casares, José Ramón Gutiérrez; Brown, Amber; Bean-Mayberry, Bevanne; Goldstein, Kenneth M.; Driscoll, Mary; Haskell, Sally G.; Bastian, Lori A.; Brandt, Cynthia

doi:10.1016/j.whi.2019.10.003

Cited by 22 publications

(14 citation statements)

References 25 publications

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“…With the rising proportion of veterans who are women, ensuring that providers are properly trained to address heart disease prevention for women as well as for men is a necessary, complementary focus (Mattocks et al, 2020). According to one national survey, most physicians knew that men and women present with different risks for heart disease but only 22% of primary care providers and 42% of cardiologists reported feeling “extremely well prepared” to assess heart disease risk in women specifically (Bairey Merz et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Post-9/11 veterans’ heart disease knowledge, self-perceived risk, and prevention beliefs and behaviors.

et al. 2021

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Objective: Veterans, including the growing number of women veterans, have a greater risk of heart disease than nonveterans, and the incidence of heart disease is increasing among the most recent veterans who participated in post-9/11 military conflicts. Investigating heart disease-related knowledge, self-perceived risk, and prevention beliefs and behavior among these veterans, and identifying potential differences in knowledge, risk, beliefs and behavior between men and women, may guide prevention strategies. Method: Cross-sectional data from a nationwide survey of 1,141 (53% women) post-9/11 veterans were used to examine heart disease awareness and information-seeking, perceived risk and importance of heart disease risk factors, beliefs about traditional (e.g., weight, blood pressure) and nontraditional (e.g., stress, sleep) factors, and engagement in prevention behaviors. Differences between men and women were also tested, using t-tests, chi-square, and Fisher's exact tests. Results: Only one-third reported they felt very informed or sought information about heart disease, or that their providers had discussed heart disease with them. Although veterans generally believe that addressing traditional and nontraditional factors can reduce their risk of heart disease, far fewer endorsed the value of mental health treatment in prevention. Overall, women were slightly more knowledgeable about heart disease risk, and of behaviors that can lower this risk, but for both men and women, this knowledge did not translate to engaging in equivalent prevention behaviors. Conclusions: Post-9/11 veterans, and potentially their providers, may each benefit from improved education regarding their risk of heart disease. Veterans may also require better, more personalized approaches to prevention.

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Section: Discussionmentioning

confidence: 99%

Post-9/11 veterans’ heart disease knowledge, self-perceived risk, and prevention beliefs and behaviors.

et al. 2021

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“…28 Women Veterans more often have suboptimal experiences in specialty care, and clinician communication and education need improvement; for example, women Veterans have reported feeling that specialty clinicians did not take their symptoms seriously or told them that their health conditions or symptoms were attributable to hormonal fluctuations. 29 VA clinicians are less likely to order LDLlowering medications for women Veterans compared to men 30 and women Veterans also decline lipid-lowering therapy more often than men, 30 which may be attributable to sub-optimal clinician-patient communication, precluding women from understanding their risk. 31 Another reason for the undertreatment of women with evidence-based medications may be related to the underlying etiology and manifestation of cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans

et al. 2022

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Background There is an increasing burden of cardiovascular disease, including coronary artery disease (CAD) and heart failure (HF), among women Veterans. Clinical practice guidelines recommend multiple pharmacotherapies that can reduce risk of mortality and adverse cardiovascular outcomes. Objective To determine if there are disparities in the use of guideline-directed medical therapy by gender among Veterans with incident CAD and HF. Design Retrospective. Participants Veterans (934,504; 87.8% men and 129,469; 12.2% women) returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Main Measures Differences by gender in the prescription of Class 1, Level of Evidence A guideline-directed medical therapy among patients who developed incident CAD and HF at 30 days, 90 days, and 12 months after diagnosis. For CAD, medications included statins and antiplatelet therapy. For HF, medications included beta-blockers and renin-angiotensin-aldosterone system inhibitors. Key Results Overall, women developed CAD and HF at a younger average age than men (mean 45.8 vs. 47.7 years, p<0.001; and 43.7 vs. 45.4 years, p<0.02, respectively). In the 12 months following a diagnosis of incident CAD, the odds of a woman receiving a prescription for at least one CAD drug was 0.85 (95% confidence interval [CI], 0.68–1.08) compared to men. In the 12 months following a diagnosis of incident HF, the odds of a woman receiving at least one HF medication was 0.54 (95% CI, 0.37–0.79) compared to men. Conclusions Despite guideline recommendations, young women Veterans have approximately half the odds of being prescribed guideline-directed medical therapy within 1-year after a diagnosis of HF. These results highlight the need to develop targeted strategies to minimize gender disparities in CVD care to prevent adverse outcomes in this young and growing population.

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“…Women in general (including Veterans) have articulated perceptions of bias in pain care, which may explain these differences. 13,24,25 Veterans also, however, cite fears of side effects and/or interference in ability to perform daily responsibilities as reasons to decline them. 13 It has previously been proposed that reduced rates of prescription opioid medications in women Veterans may be related to gender differences in underlying conditions, such as widespread pain conditions (eg, fibromyalgia) and headache/migraine; 26 however, our analyses identified lower opioid prescribing in women even after controlling for type of chronic pain, indicating that there are other causes for this discrepancy.…”

Section: Discussionmentioning

confidence: 99%

Rurality impacts pain care for female veterans similarly to male veterans

Hadlandsmyth

Driscoll

Mares

et al. 2022

The Journal of Rural Health

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Purpose Rural disparities exist in access to multidisciplinary pain care with higher rates of opioid prescribing in rural regions. Among Veterans, who have prevalent rates of chronic pain, women often evidence complex presentations, multiple comorbidities, and dissatisfaction with care. This study investigates the impact of rurality on pain care for women specifically, and whether this varies from the impact of rurality for men. Methods A cohort of Veterans with chronic pain in 2018 was built utilizing VA administrative data. Variables of interest included: demographic, comorbidities, medications, and health care utilization for chronic pain. Findings The cohort included 2,261,030 Veterans; 11% (n = 248,977) were women. Significantly fewer women (7%) compared to men (10.7%) received long‐term opioids (adjusted OR = 0.77, 95% CI: 0.75‐0.78). Men, relative to women, were also more likely to receive gabapentinoids and nonsteroidal ant‐inflammatory drugs, whereas women, relative to men, were more likely to receive muscle relaxants and duloxetine. Women were more likely to receive most psychiatric medications. Rural women received more primary care visits compared to urban women (adjusted OR = 1.19, 95% CI: 1.15‐1.22), but fewer women's clinic visits (a subset of primary care visits: adjusted OR = 0.69, 95% CI:0.67‐0.71) and fewer pain specialty care visits (physical therapy, pain clinic, and mental health visits with pain codes). Rural effects did not vary substantially between women and men. Conclusions Rural‐dwelling Veterans received more pain and psychiatric medications compared to urban Veterans and fewer specialty care visits. Rural Veterans may benefit from increased access to specialty chronic pain care.

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Women Veterans’ Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care

Cited by 22 publications

References 25 publications

Post-9/11 veterans’ heart disease knowledge, self-perceived risk, and prevention beliefs and behaviors.

Post-9/11 veterans’ heart disease knowledge, self-perceived risk, and prevention beliefs and behaviors.

Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans

Rurality impacts pain care for female veterans similarly to male veterans

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