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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

1048 — Cardiac Risk Profile of Women Veterans

Whitehead AM, Women Veterans Health Strategic Health Care Group, VA Central Office; Haskell SG, VA Connecticut Healthcare System, Women Veterans Health Strategic Health Care Group, VA Central Office; Yale School of Medicine; Davis MB, VA Ann Arbor Healthcare System, University of Michigan; Frayne SM, Women’s Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Healthcare System; Stanford University; Friedman SA, Women’s Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Healthcare System; Schmitt SK, Women’s Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Healthcare System; Health Economics Resource Center; Berg E, Women’s Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Healthcare System; Hayes PM, Women Veterans Health Strategic Health Care Group, VA Central Office; Phibbs CS, Women’s Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Healthcare System; Health Economics Resource Center; Stanford;

Objectives:
The number of women Veteran VA users, and the proportion aged 45-64, has grown dramatically over the past decade. Many will experience cardiovascular events (leading killer of women) as they age. To inform VA’s clinical program planning efforts, we examined rates of cardiovascular risk factors (RFs) among women Veterans aged 45-64 in FY00 and in FY09, and determined odds of cardiovascular RFs in women benchmarked against men.

Methods:
We created cohorts of Veteran VA users aged 45-64: one for FY00 and one for FY09, based on VA outpatient utilization files. We used Agency for Health Research and Quality’s Clinical Classifications Software (with minor modifications) to group ICD9 codes into cardiovascular RF categories. We examined rates of diabetes, hypertension, dyslipidemia, tobacco use disorders, and less classic RFs: overweight/obesity, and depression in women, and generated age-adjusted odds ratios (AOR) for presence of these cardiovascular RFs among women versus men in FY00 and in FY09.

Results:
Cohorts included 46,267 women (1,249,538 men) in FY00, and 126,385 (2,024,778) in FY09. Rates of cardiovascular RFs increased for both women and men. Rates among women in FY00 and FY09, respectively, were: diabetes (11.3%, 17.9%), hypertension (30.9%, 39.6%), dyslipidemia (21.5%, 41.0%), tobacco use disorders (9.2%, 19.2%), overweight/obesity (1.5%, 23.4%), and depression (22.5%, 29.2%). In FY09, women were less likely than men to have diabetes, hypertension, dyslipidemia, or tobacco use (AOR: 0.67, 0.70, 0.80, 0.72), but more likely to have obesity and depression (AOR: 1.33, 1.61); FY00 AOR’s were similar, and all were significant (p <0.05).

Implications:
While advances in disease ascertainment may partially account for increases in cardiovascular RF rates from FY00 to FY09, the key finding was that many women aged 45-64 have such RFs. Women are more likely to be diagnosed with overweight/obesity and depression than men.

Impacts:
The large, increasing number of women Veterans aged 45-64 with cardiovascular RFs is likely to require more intensive services for incident cardiovascular disease as they age. High rates of depression, a known cardiovascular RF, may amplify risk and raise the possibility that women may require tailored approaches to prevention and treatment of cardiovascular disease (e.g., coordination of cardiovascular and mental health services).


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