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BACKGROUND/RATIONALE:
The proportion of women in the military, their roles, demographics and their exposure to combat has changed dramatically during Operation Enduring Freedom and Operation Iraqi Freedom. The impact of these significant changes on women's health care needs and utilization remain largely unknown. As the population of female veterans using the VA health system may double in the next 5-10 years and the effects of the 1998 entitlement for 2 years of healthcare coverage for combat veterans become apparent, an understanding of female veteran healthcare utilization patterns will be increasingly necessary. It is imperative for the VA to understand and explore the health care needs of women serving in combat or combat zones in order to plan for future health care treatment and resource allocation that may differ by sex.
The creation of an HSR&D cohort of OEF/OIF female veterans and appropriately matched male veterans is vital to beginning the study necessary for health resource planners and providers. Results can be obtained rapidly as the process has been previously demonstrated and tested with the VACS virtual cohort and the West Haven, CT OEF/OIF pilot cohort. By supplementing the data in the national cohort with prospective patient-specific data, this national cohort resource can subsequently be used to begin assessing the impact of sex, combat, sexual trauma, service, age and race on healthcare utilization, costs and medical and psychiatric outcomes.
OBJECTIVE(S):
The primary objective of our project, "Women's Healthcare Evaluation of Resource Utilization and Outcomes Assessment" (HERA), is to identify important factors of gender-associated disparities in health care utilization and outcomes among OEF/OIF veterans receiving care within the VA system.
Project Objectives and Aims.
Aim I. To assess health care utilization, costs, and satisfaction during the complete 2 year healthcare coverage after discharge from service among female and male OEF/OIF veterans.
Aim II. To assess changes in healthcare utilization, costs and satisfaction after the 2-year complete healthcare coverage ends.
Aim III. To compare the diagnosis and treatment of stress associated conditions during the 2-year complete healthcare coverage.
METHODS:
We propose to collect data on OEF/OIF women and matched men controls in an HSR&D cohort and follow them longitudinally in order to determine the effect of sex on health services utilization and costs, and health outcomes. Replicating and building on methods used for the nationally recognized Veterans Aging Cohort Study we will, 1) design a VA national cohort of female and age, race, combat end date, and network matched male veterans of OEF/OIF; and 2) supplement the data in this cohort with prospective patient-collected survey data from West Haven, CT VA and Indianapolis, IN VA.
The proposed project will require five years: 0.5 years for observational cohort creation and concurrently 1.5 years for subject enrollment at the 2 sites; 3 years for longitudinal follow up; and .5 year for final follow-up and for final analyses, report writing and designing an intervention study based upon the study's findings. Data sources employed will include the VAMC computerized medical record, clinical, pharmacy, laboratory data and patient completed surveys.
FINDINGS/RESULTS:
Of the 406,802 veterans included in the roster, 49,067 (12.1%) were female. Female veterans were younger (33 years versus 35 years) and more likely to be Black (29% versus 15%).
In unadjusted analyses, a slightly lower proportion of females used VA services (43.1% versus 43.8%), and females had higher median total costs among users of VA services ($1,304 versus $1,118) compared with males. After adjusting for education, age, race, rank in the military, and branch of service, females were significantly more likely to use any VA services in the year after discharge (odds ratio=1.08, 95% confidence interval: 1.06-1.10). Females also had significantly higher logged total health care costs among veterans receiving any VA care (beta=0.158, p<0.0001).
Female veterans were less likely to report pain (41.0% versus 46.6%, p <0.001). Among those who reported pain, female veterans were more likely to have a pain score >4 (70.5% versus 65.7%, p <0.001). After adjusting for age, race, marital status, education, rank, branch of service, and comorbidity, female veterans remained less likely to report pain (OR 0.82, 95% CI 0.79,0.85) and for those with pain, more likely to have pain score >4 (OR 1.23, 95% CI 1.16-1.30).
IMPACT:
Because female OEF/OIF veterans comprise a greater proportion of veterans than in previous military cohorts, it is important to understand how their health care needs are different from those of male veterans. This study is the first of a larger agenda to understand these health care needs. The finding that female veterans are both more likely to use VA services and have higher costs among users of VA care emphasizes the need to be prepared for the changing VA population.
Pain is frequent among veterans of war. OEF/OIF females comprise a greater proportion of returning veterans than ever before. The surprising finding that female veterans are less likely to have pain, (although those with pain are more likely than men to have clinically significant pain ) deserves further investigation. Our ongoing Women Veterans Cohort Prospective Survey will provide further explanation of gender differences in pain in OEF-OIF veterans.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Military and Environmental Exposures, Special (Underserved, High Risk) Populations
DRE:
Resource Use and Cost, Epidemiology, Quality of Care
Keywords:
Women - or gender differences, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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