3166 — Trends in the Disease Burden of Women Veteran VHA Patients from 2003-2012

Saechao F, VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Balasubramanian V, VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Maisel NC, VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Berg E, VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Haskell S, Women's Health Services, VA Central Office; Yale University School of Medicine; VA Connecticut Health Care System; Hayes PM, Women's Health Services, VA Central Office; Phibbs CS, VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine; Iqbal S, Women's Health Section, Medical Service, VA Palo Alto Health Care System; Lee JS, VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine; Frayne SM, VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine

Objectives:
With the influx of young women Veterans (WV) returning from Iraq and Afghanistan with unique war exposures, the swelling older WV population, and the natural history of diseases, shifting trends in the disease burden of WV patients are expected. We compared the disease profile of the Veterans Health Administration (VHA) WV population in FY03 and the VHA WV population in FY12.

Methods:
After mapping each ICD-9-CM code to one of 202 conditions (algorithm modified from Agency for Healthcare Research and Quality's Clinical Classification Software), we used VHA/Fee outpatient/inpatient administrative data to identify proportions of WV patients with each condition in FY03 and FY12. We then calculated percent change in proportions for each condition (100 x [FY12 proportion minus FY03 proportion, divided by FY03 proportion]), by age group.

Results:
We included all 200,807 FY03 and all 362,014 FY12 WV patients. Among conditions diagnosed in at least 5% of WV in each age group in FY12, conditions with the top five "percent changes" by age group were: 18-44 year olds - Pregnancy/Delivery (119%), Adjustment Disorders (107%), Posttraumatic Stress Disorder (106%), Cervical Spine Disorders (68%), Overweight/Obesity (65%); 45-64 year olds - Vitamin D Deficiency (14765%), Chronic Pain Syndromes (1162%), Sleep Apnea (283%), Cataract (112%), Posttraumatic Stress Disorder (72%); 65+ year olds - Vitamin D Deficiency (6762%), Renal Failure/Nephropathy (203%), Refraction Disorders (88%), Overweight/Obesity (85%), Hearing Problems (78%). Some conditions also decreased over the decade, most notably Disorders of Unspecified/Multiple Joints (-30%) among WV 18-44 years, and Menopausal Disorders for both WV age 45-64 (-38%) and 65+ year olds (-46%).

Implications:
The proportion of WV diagnosed with a range of conditions has increased over the past decade. It is unknown whether this reflects increases in prevalence of some conditions and/or changes in 1) detection (through screening initiatives, increased clinician awareness, new disease ascertainment technology), 2) coding practices, 3) condition-specific service availability, and/or 4) numbers of women turning to VHA for treatment of these conditions.

Impacts:
While administrative data cannot detect true prevalence of conditions among women Veteran VHA patients, these data highlight emerging secular trends in condition frequencies, with potential impact on design strategies for VHA's women's health care delivery system.