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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3077 — Patterns of Risk Factors Commonly Screened For in VA Primary Care Settings: A Latent Class Analysis Using National Data

Funderburk JSMaisto SA, and Kenneson A, Center for Integrated Healthcare, Syracuse VAMC;

VA primary care providers regularly screen for risk factors associated with modifiable health behaviors during primary care visits, including elevated blood pressure, obesity, smoking, depression, alcohol misuse, and symptoms of post-traumatic stress disorder (PTSD). Past research has shown that a significant number of Veterans screen positive on more than one of these screens and there appears to be a high level of healthcare utilization among Veterans screening positive on certain clusters of these screens within VISN 2. This study intends to build upon past research and examine the covariation of these screens using national VA data.

Data were merged from several VA databases to result in a random sample of Veterans (N = 28,573), who had a primary care visit within the VA during 2008 and had information regarding all six identified risk factors (i.e., elevated blood pressure, obesity, smoking, depression, alcohol misuse, and PTSD). Two equal-sized random samples (N = 12,286) were created to use in the exploratory and confirmatory latent class analysis (LCA) to examine the covariation among the screens.

Due to a high prevalence of Veterans meeting criteria for elevated blood pressure (72%) and overweight/obese BMI’s (81%), these variables were not included in the LCA. Exploratory and confirmatory LCA yielded a 3-cluster best-fitting model. Specifically, Veterans screening positive for PTSD symptoms had the highest likelihood of being in Cluster 3, which also had a higher probability of screening positive on the other three risk factors. Cluster 2 included Veterans who had a high likelihood of screening positive for smoking and alcohol, but not depression or PTSD. Veterans in Cluster 1 had the lowest probability of screening positive on any of the four risk factors.

Similar to past research, these results suggest there are specific clusters of risk factors associated with modifiable health behaviors that may be worth targeting.

As the VA continues to strive to improve healthcare for Veterans, identifying specific clusters of these risk factors among Veterans can help guide further research examining factors that influence health outcomes, as well as potential interventions addressing common co-occurring health behaviors.

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