Racial and Ethnic Disparities in U.S. Veteran Health Characteristics
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Demographics
3.2. Lifestyle Characteristics
3.3. Military Service and Combat Exposures
3.4. Health-Related Characteristics
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Unadjusted | Age-Standardized | |||||
---|---|---|---|---|---|---|---|
White | Black | p-Value | Hispanic | p-Value | Other | p-Value | |
(n = 317,782) | (n = 42,951) | (n = 29,427) | (n = 8782) | ||||
Age, years, mean (SD) | 66.8 (11.7) | 60.7 (10.6) | 60.9 (13.6) | 60.3 (13.7) | |||
Age category (%) | |||||||
18–45 | 5.30 | 7.50 | 13.93 | 15.29 | |||
>45–64 | 29.69 | 56.41 | 41.49 | 41.58 | |||
≥65 | 65.02 | 36.09 | 44.58 | 43.14 | |||
Married or cohabitating with partner (%) | 66.21 | 51.96 | <0.0001 | 61.99 | <0.0001 | 65.00 | 0.0021 |
Education level, ≥some college (%) | 75.22 | 70.34 | <0.0001 | 69.39 | <0.0001 | 81.92 | <0.0001 |
Annual household income (%) | <0.0001 | <0.0001 | 0.56962 | ||||
<$30,000 | 33.19 | 44.08 | 40.25 | 33.06 | |||
$30,000–$59,999 | 35.66 | 32.58 | 35.83 | 34.82 | |||
$60,000–$99,999 | 19.97 | 16.79 | 16.80 | 20.10 | |||
≥$100,000 | 11.17 | 6.55 | 7.11 | 12.02 | |||
Smoking status (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Never | 26.3 | 27.0 | 32.6 | 28.1 | |||
Former | 67.7 | 66.6 | 61.5 | 65.8 | |||
Current | 6.0 | 6.4 | 5.9 | 6.1 | |||
Alcohol use (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Never | 7.3 | 8.8 | 8.0 | 11.6 | |||
Former | 37.1 | 47.8 | 43.5 | 44.1 | |||
Current | 55.6 | 43.4 | 48.5 | 44.3 | |||
Current physical fitness status (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Very good to fairly good | 39.1 | 30.6 | 32.3 | 31.8 | |||
Satisfactory | 34.0 | 37.0 | 36.1 | 36.4 | |||
Fairly poor to very poor | 26.9 | 32.3 | 31.6 | 31.7 | |||
Current exercise frequency (%) | <0.0001 | <0.0001 | 0.0008 | ||||
≤1–3 times/month | 44.3 | 47.9 | 42.9 | 42.8 | |||
Once/week | 13.3 | 13.3 | 14.2 | 14.2 | |||
2–4 times/week | 28.4 | 27.1 | 28.3 | 28.4 | |||
≥5 times/week | 14.0 | 11.7 | 14.6 | 14.6 | |||
Service era (%) | <0.0001 | <0.0001 | <0.0001 | ||||
September 2001 or later | 9.2 | 8.1 | 9.9 | 11.4 | |||
August 1990 to August 2001 (includes Gulf War) | 15.0 | 15.2 | 15.4 | 19.9 | |||
May 1975 to July 1990 | 24.5 | 26.2 | 22.6 | 31.2 | |||
August 1964 to April 1975 (Vietnam era) | 58.5 | 58.1 | 56.2 | 58.5 | |||
February 1955 to July 1964 | 17.6 | 15.7 | 14.8 | 14.2 | |||
July 1950 to January 1955 (Korean War) | 9.9 | 10.0 | 10.5 | 9.3 | |||
January 1947 to June 1950 | 1.5 | 1.4 | 1.4 | 1.3 | |||
December 1941 to December 1946 (WWII) | 4.1 | 3.0 | 3.0 | 2.9 | |||
November 1941 or earlier | 0.2 | 0.2 | 0.2 | 0.1 | |||
Branch of service (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Army | 47.3 | 59.0 | 56.8 | 48.3 | |||
Navy | 24.1 | 13.0 | 16.2 | 27.2 | |||
Air Force | 18.6 | 18.9 | 14.8 | 15.7 | |||
Marine Corps | 11.5 | 11.0 | 14.4 | 10.9 | |||
Other | 7.7 | 5.3 | 8.3 | 7.7 | |||
Military Exposures | |||||||
Combat experiences scale 1 (15–75) mean (SD) | 25.0 (11.3) | 26.1 (13.2) | <0.0001 | 27.5 (13.3) | <0.0001 | 26.1 (13.0) | <0.0001 |
Brief Traumatic Brain Injury Screen (%) | 25.3 | 29.0 | <0.0001 | 36.4 | <0.0001 | 37.0 | <0.0001 |
Chemical or biological warfare agent exposure 2 (%) | 81.6 | 76.2 | <0.0001 | 78.6 | <0.0001 | 83.2 | 0.0681 |
Characteristic | Unadjusted | Age-Standardized | |||||
---|---|---|---|---|---|---|---|
White | Black | p-Value | Hispanic | p-Value | Other | p-Value | |
(n = 26,139) | (n = 7632) | (n = 3482) | (n = 1218) | ||||
Age, years, mean (SD) | 55.0 (13.4) | 51.8 (10.7) | 48.1 (13.6) | 50.1 (12.7) | |||
Age category (%) | |||||||
18–45 | 22.79 | 25.84 | 43.44 | 35.63 | |||
>45–64 | 55.45 | 65.23 | 45.76 | 51.89 | |||
≥65 | 21.76 | 8.92 | 10.80 | 12.48 | |||
Married or cohabitating with partner (%) | 42.97 | 28.11 | <0.0001 | 36.88 | <0.0001 | 43.17 | 0.79153 |
Education level, ≥some college (%) | 90.76 | 92.41 | 0.00618 | 90.80 | 0.54979 | 93.98 | 0.00169 |
Annual household income (%) | <0.0001 | 0.03078 | 0.78796 | ||||
<$30,000 | 34.21 | 37.03 | 34.03 | 34.38 | |||
$30,000–$59,999 | 33.33 | 35.31 | 35.38 | 32.24 | |||
$60,000–$99,999 | 19.44 | 18.67 | 19.57 | 19.23 | |||
≥$100,000 | 13.03 | 8.99 | 11.02 | 14.15 | |||
Smoking status (%) | <0.0001 | <0.0001 | 0.0002 | ||||
Never | 39.7 | 49.5 | 49.4 | 44.4 | |||
Former | 54.1 | 44.9 | 44.9 | 49.4 | |||
Current | 6.2 | 5.6 | 5.6 | 6.2 | |||
Alcohol use (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Never | 9.5 | 15.4 | 15.6 | 20.4 | |||
Former | 33.8 | 35.2 | 29.3 | 34.4 | |||
Current | 56.7 | 49.4 | 55.1 | 45.2 | |||
Current physical fitness status (%) | 0.0017 | 0.0006 | 0.8645 | ||||
Very good to fairly good | 34.5 | 30.8 | 31.7 | 33.8 | |||
Satisfactory | 33.7 | 37.7 | 35.6 | 33.5 | |||
Fairly poor to very poor | 31.8 | 31.4 | 32.7 | 32.6 | |||
Current exercise frequency (%) | <0.0001 | 0.0195 | 0.0024 | ||||
≤1–3 times/month | 47.7 | 49.9 | 43.8 | 43.1 | |||
Once/week | 13.3 | 13.0 | 14.8 | 12.6 | |||
2–4 times/week | 27.9 | 27.7 | 30.5 | 31.3 | |||
≥5 times/week | 11.1 | 9.4 | 10.9 | 12.9 | |||
Service era (%) | <0.0001 | <0.0001 | <0.0001 | ||||
September 2001 or later | 28.6 | 31.3 | 34.1 | 36.2 | |||
August 1990 to August 2001 (includes Gulf War) | 40.5 | 47.2 | 41.2 | 42.6 | |||
May 1975 to July 1990 | 49.4 | 49.5 | 44.5 | 47.2 | |||
August 1964 to April 1975 (Vietnam era) | 25.1 | 18.7 | 21.0 | 20.7 | |||
February 1955 to July 1964 | 4.8 | 3.8 | 5.0 | 4.0 | |||
July 1950 to January 1955 (Korean War) | 2.2 | 2.5 | 2.1 | 1.4 | |||
January 1947 to June 1950 | 0.2 | 0.2 | 0.0 | 0.0 | |||
December 1941 to December 1946 (WWII) | 1.3 | 0.6 | 0.8 | 0.6 | |||
November 1941 or earlier | 0.04 | 0.04 | 0.1 | 0.0 | |||
Branch of service (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Army | 43.7 | 60.1 | 51.3 | 48.3 | |||
Navy | 24.1 | 15.3 | 20.0 | 27.2 | |||
Air Force | 25.8 | 20.1 | 21.0 | 15.7 | |||
Marine Corps | 6.5 | 4.2 | 7.5 | 10.9 | |||
Other | 9.0 | 7.8 | 8.5 | 7.7 | |||
Military Exposures | |||||||
Combat experiences scale 1, (15–75) mean (SD) | 19.4 (7.43) | 20.0 (8.74) | 0.0021 | 21.2 (7.54) | 0.0005 | 20.3 (9.49) | 0.0563 |
Brief Traumatic Brain Injury Screen (%) | 15.1 | 19.7 | 0.0002 | 24.2 | <0.0001 | 26.4 | 0.0019 |
Chemical or biological warfare agent exposure 2 (%) | 65.2 | 62.5 | 0.0033 | 66.3 | 0.2722 | 74.0 | <0.0001 |
Characteristic | Unadjusted | Age-Standardized | |||||
---|---|---|---|---|---|---|---|
White | Black | p-Value | Hispanic | p-Value | Other | p-Value | |
(n = 317,782) | (n = 42,951) | (n = 29,427) | (n = 8782) | ||||
Current health status (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Good to excellent | 63.1 | 48.8 | 53.3 | 53.6 | |||
Fair to poor | 36.9 | 51.2 | 46.7 | 46.4 | |||
Lifetime health conditions (No.), mean (SD) | |||||||
Total health conditions (0–75) | 7.52 (4.60) | 7.42 (5.11) | <0.0001 | 7.82 (5.35) | <0.0001 | 8.33 (5.62) | <0.0001 |
Circulatory conditions (0–10) | 1.82 (1.49) | 1.88 (1.44) | <0.0001 | 1.79 (1.49) | 0.0003 | 1.91 (1.55) | <0.0001 |
Skeletomuscular conditions (0–6) | 0.79 (0.90) | 0.85 (0.98) | <0.0001 | 0.80 (0.97) | 0.9270 | 0.95 (1.06) | <0.0001 |
Mental health conditions (0–10) | 0.70 (1.21) | 0.90 (1.43) | <0.0001 | 1.01 (1.52) | <0.0001 | 0.93 (1.49) | <0.0001 |
Hearing and vision conditions (0–6) | 1.16 (1.08) | 0.88 (1.07) | <0.0001 | 1.14 (1.14) | 0.0074 | 1.24 (1.17) | <0.0001 |
Infectious diseases (0–4) | 0.08 (0.29) | 0.16 (0.42) | <0.0001 | 0.12 (0.37) | <0.0001 | 0.13 (0.37) | <0.0001 |
Kidney conditions (0–3) | 0.07 (0.28) | 0.12 (0.38) | <0.0001 | 0.10 (0.34) | <0.0001 | 0.11 (0.35) | <0.0001 |
Gastrointestinal conditions (0–9) | 0.75 (0.89) | 0.64 (0.90) | <0.0001 | 0.72 (0.95) | <0.0001 | 0.73 (0.97) | <0.0001 |
Cancers (0–6) | 0.39 (0.62) | 0.26 (0.51) | <0.0001 | 0.22 (0.50) | <0.0001 | 0.25 (0.52) | <0.0001 |
Neurological conditions (0–12) | 0.56 (1.01) | 0.52 (0.99) | <0.0001 | 0.63 (1.13) | <0.0001 | 0.71 (1.19) | <0.0001 |
Other conditions (0–9) | 1.19 (1.15) | 1.22 (1.18) | 0.0231 | 1.30 (1.21) | <0.0001 | 1.37 (1.25) | <0.0001 |
Pain intensity, past week (%) | <0.0001 | <0.0001 | <0.0001 | ||||
No pain (0) | 12.6 | 10.6 | 11.0 | 9.8 | |||
Mild pain (1–3) | 40.8 | 24.5 | 27.6 | 29.9 | |||
Moderate pain (4–6) | 27.9 | 30.3 | 31.0 | 29.8 | |||
Severe pain (7–10) | 18.7 | 34.6 | 30.5 | 30.4 | |||
VA health care use, past year (%) | <0.0001 | <0.0001 | <0.0001 | ||||
None | 9.3 | 7.7 | 9.2 | 10.0 | |||
Less than half of care | 27.4 | 22.8 | 28.4 | 31.0 | |||
More than half of care | 23.8 | 26.0 | 22.1 | 24.0 | |||
All care | 39.6 | 43.4 | 40.4 | 35.0 | |||
VA inpatient hospital stays, past year (%) | <0.0001 | <0.0001 | <0.0001 | ||||
None | 81.7 | 73.4 | 75.1 | 77.6 | |||
1–3 | 15.3 | 21.1 | 19.6 | 17.7 | |||
≥4 | 3.0 | 5.6 | 5.3 | 4.7 | |||
Current prescription medications from VA (%) | <0.0001 | <0.0001 | <0.0001 | ||||
None | 16.6 | 9.9 | 13.2 | 15.6 | |||
1–3 | 29.3 | 22.4 | 26.8 | 27.4 | |||
4–6 | 26.8 | 29.0 | 27.7 | 26.3 | |||
≥7 | 27.2 | 38.8 | 32.4 | 30.7 | |||
Current prescription medications outside VA (%) | <0.0001 | <0.0001 | <0.0001 | ||||
None | 40.9 | 39.4 | 37.2 | 34.2 | |||
1–3 | 34.4 | 32.6 | 33.6 | 33.1 | |||
4–6 | 16.4 | 17.0 | 18.3 | 19.3 | |||
≥7 | 8.3 | 11.1 | 10.9 | 13.3 |
Characteristic | Unadjusted | Age-Standardized | |||||
---|---|---|---|---|---|---|---|
White | Black | p-Value | Hispanic | p-Value | Other | p-Value | |
(n = 26,139) | (n = 7632) | (n = 3482) | (n = 1218) | ||||
Current health status (%) | <0.0001 | <0.0001 | <0.0001 | ||||
Good to excellent | 67.3 | 59.5 | 60.4 | 61.5 | |||
Fair to poor | 32.7 | 40.5 | 39.6 | 38.5 | |||
Lifetime health conditions (No.), mean (SD) | |||||||
Total health conditions (0–75) | 7.17 (4.70) | 6.53 (4.42) | <0.0001 | 6.92 (4.90) | 0.0068 | 7.55 (5.47) | 0.2021 |
Circulatory conditions (0–10) | 1.06 (1.16) | 1.23 (1.16) | <0.0001 | 1.02 (1.14) | 0.1095 | 1.14 (1.26) | 0.0644 |
Skeletomuscular conditions (0–6) | 0.99 (0.99) | 0.89 (0.95) | <0.0001 | 0.93 (0.99) | 0.0160 | 1.04 (1.08) | 0.8113 |
Mental health conditions (0–10) | 1.34 (1.51) | 1.22 (1.48) | <0.0001 | 1.41 (1.56) | 0.1369 | 1.43 (1.70) | 0.3961 |
Hearing and vision conditions (0–6) | 0.61 (0.84) | 0.48 (0.76) | <0.0001 | 0.58 (0.84) | 0.2437 | 0.65 (0.88) | 0.0559 |
Infectious diseases (0–4) | 0.07 (0.27) | 0.10 (0.32) | <0.0001 | 0.09 (0.31) | 0.0028 | 0.11 (0.32) | 0.0002 |
Kidney conditions (0–3) | 0.04 (0.21) | 0.04 (0.22) | 0.0691 | 0.04 (0.20) | 0.4836 | 0.05 (0.24) | 0.1110 |
Gastrointestinal conditions (0–9) | 0.86 (1.00) | 0.74 (0.94) | <0.0001 | 0.79 (1.00) | 0.0001 | 0.82 (1.02) | 0.0059 |
Cancers (0–6) | 0.23 (0.49) | 0.11 (0.34) | <0.0001 | 0.14 (0.39) | <0.0001 | 0.15 (0.41) | <0.0001 |
Neurological conditions (0–12) | 0.90 (1.19) | 0.67 (0.99) | <0.0001 | 0.87 (1.17) | 0.0359 | 0.98 (1.32) | 0.1485 |
Other conditions (0–9) | 1.07 (1.14) | 1.05 (1.10) | 0.5047 | 1.06 (1.16) | 0.6481 | 1.18 (1.17) | 0.0090 |
Pain intensity, past week (%) | <0.0001 | <0.0001 | <0.0001 | ||||
No pain (0) | 9.9 | 9.0 | 9.7 | 9.0 | |||
Mild pain (1–3) | 33.7 | 21.6 | 26.3 | 25.4 | |||
Moderate pain (4–6) | 30.6 | 30.6 | 30.1 | 29.6 | |||
Severe pain (7–10) | 25.7 | 38.8 | 33.9 | 36.0 | |||
VA health care use, past year (%) | 0.6526 | <0.0001 | 0.0005 | ||||
None | 7.6 | 6.5 | 8.1 | 7.9 | |||
Less than half of care | 20.3 | 21.9 | 25.4 | 25.8 | |||
More than half of care | 26.6 | 25.2 | 23.7 | 24.5 | |||
All care | 45.5 | 46.5 | 42.8 | 41.9 | |||
VA inpatient hospital stays, past year (%) | <0.0001 | 0.0002 | 0.0863 | ||||
None | 84.2 | 81.8 | 81.5 | 81.5 | |||
1–3 | 13.4 | 15.3 | 15.2 | 16.3 | |||
≥4 | 2.4 | 2.9 | 3.3 | 2.2 | |||
Current prescription medications from VA (%) | <0.0001 | 0.8191 | 0.8113 | ||||
None | 15.8 | 10.7 | 15.3 | 15.8 | |||
1–3 | 31.3 | 28.4 | 31.6 | 30.4 | |||
4–6 | 25.0 | 29.2 | 25.8 | 25.0 | |||
≥7 | 27.9 | 31.7 | 27.3 | 28.8 | |||
Current prescription medications outside VA (%) | <0.0001 | 0.0064 | 0.0014 | ||||
None | 55.2 | 49.8 | 51.2 | 49.0 | |||
1–3 | 30.1 | 32.3 | 33.1 | 31.5 | |||
4–6 | 9.7 | 12.3 | 10.9 | 12.5 | |||
≥7 | 5.0 | 5.6 | 4.8 | 7.0 |
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Ward, R.E.; Nguyen, X.-M.T.; Li, Y.; Lord, E.M.; Lecky, V.; Song, R.J.; Casas, J.P.; Cho, K.; Gaziano, J.M.; Harrington, K.M.; et al. Racial and Ethnic Disparities in U.S. Veteran Health Characteristics. Int. J. Environ. Res. Public Health 2021, 18, 2411. https://doi.org/10.3390/ijerph18052411
Ward RE, Nguyen X-MT, Li Y, Lord EM, Lecky V, Song RJ, Casas JP, Cho K, Gaziano JM, Harrington KM, et al. Racial and Ethnic Disparities in U.S. Veteran Health Characteristics. International Journal of Environmental Research and Public Health. 2021; 18(5):2411. https://doi.org/10.3390/ijerph18052411
Chicago/Turabian StyleWard, Rachel E., Xuan-Mai T. Nguyen, Yanping Li, Emily M. Lord, Vanessa Lecky, Rebecca J. Song, Juan P. Casas, Kelly Cho, John Michael Gaziano, Kelly M. Harrington, and et al. 2021. "Racial and Ethnic Disparities in U.S. Veteran Health Characteristics" International Journal of Environmental Research and Public Health 18, no. 5: 2411. https://doi.org/10.3390/ijerph18052411