Egede LE (Charleston VA REAP), Lynch CS
(Charleston VA REAP)
To identify the independent factors associated with VA use among a national probability sample of veterans.
Data on 33,813 veterans sampled as part of the 2003 Behavioral Risk Factor Surveillance Survey were analyzed. VA use was ascertained by the following question “In the last 12 months have you received some or all of your health care from VA facilities?" VA use was defined as receiving some or all health care from a VA facility. In unadjusted analysis, VA users were compared to non-users across demographics (age, sex, race/ethnicity, marital status), socioeconomics (education, income, employment), access to care (health insurance, access to a primary care provider), health status, and comorbidity (diabetes, hypertension, hyperlipidemia, arthritis, cardiovascular disease, stroke) categories. Multiple logistic regression was used to determine the independent factors associated with VA use adjusting for all the covariates listed above. STATA Version 10 was used for statistical analysis to account for the complex survey design and to yield population estimates.
In the US population in 2003, 14.2% (95% CI 14.0-14.5) were veterans. Among veterans, 17.2% (95% CI 16.5-17.9) received some or all of their health care from VA facilities. In unadjusted analyses, VA use differed significantly by race/ethnicity, age, education, income, marital status, employment, health status, insurance, access to primary care provider, and comorbidity status. In the full adjusted model, independent factors associated with VA use included being non-Hispanic Black OR 1.89 (95% CI 1.54-2.31), non-Hispanic Other OR 1.54 (95% CI 1.06-2.24) [reference group non-Hispanic White]; income < $50,000 OR 0.65 (95% CI 0.60-0.75), income $50,000-75,000 OR 0.47 (95% CI 0.38-0.58), income $75,000 OR 0.28 (95% CI 0.22-0.35) [reference group income < $25,000]; employment OR 0.67 (95% CI 0.57-0.79); excellent/very good/good health status OR 0.66 (95% CI 0.57-0.75); and having any of the listed comorbid conditions OR 2.12 (95% CI 1.78-2.52).
A significant proportion of veterans do not receive care from VA facilities. Ethnic minority status and having comorbid conditions are significantly associated with VA use, while higher income, employment, and good perceived health status are significantly associated with non-use of VA services.
The VA serves as an important national “safety net” provider for ethnic minority, indigent, vulnerable, and chronically ill veterans. Additional funding and coordinated strategies to expand access to VA services is necessary to maintain this important “safety net” function.