Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4066 — Chronic Multisymptom Illness among Iraq/Afghanistan-Deployed Veterans and their Healthcare Utilization

Lead/Presenter: April Mohanty, COIN - Salt Lake City
All Authors: Mohanty AF (HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, and Department of Internal Medicine, University of Utah) McAndrew LM (VA War Related Illness and Injury Study Center, New Jersey Health Care System, East Orange, NJ) Helmer DA (VA War Related Illness and Injury Study Center, New Jersey Health Care System) Samore MH (IDEAS 2.0, and Department of Internal Medicine, University of Utah) Gundlapalli AV (IDEAS 2.0, and Department of Internal Medicine, University of Utah)

Objectives:
To investigate Chronic Multisymptom Illness (CMI)-related diagnoses and healthcare utilization among male and female Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) Veterans.

Methods:
We conducted a cross-sectional study of OEF/OIF/OND Veterans with > = 1 CMI-related primary diagnosis, Fiscal Years (FY) 2002-2012. Using the International Classification of Disease-9th edition-Clinical Modification (ICD-9) we examined the prevalence of > = 1 CMI-related diagnoses including chronic fatigue syndrome (CFS, 780.71), fibromyalgia (FMS, 729.1), and irritable bowel syndrome (IBS, 564.1). Using Poisson regression models with robust errors, we estimated Prevalence Ratios (PR) and 95% Confidence Intervals (95% CIs) for demographic characteristics associated with CMI-related diagnoses. We further examined temporal variations in CMI-related healthcare utilization.

Results:
Among 501,996 male and 69,611 female OEF/OIF/OND Veterans who accessed the Veterans Health Administration (VHA) during FY2002-2012, 4.2% (N = 21,202) males and 8.4% (N = 5,835) females had > = 1 CMI-related diagnosis. Veterans with > = 1 CMI-related diagnosis were more likely to be female (vs male PR: 2.06, 95% CI: 1.99-2.13) non-black (vs black PR: 1.15, 95% CI: 1.11-1.20), and older (40+ vs 18-24 years PR: 1.32, 95% CI 1.26-1.38). Additionally, the prevalence for each CMI-related diagnosis was higher in females, the prevalence of > = 1 CFS, IBS and FMS diagnosis for females vs males was 3.3% vs 1.7%, 9.2% vs 2.6%, and 3.6% vs 1.6%, respectively. The mean yearly average number of ICD-9 coded CMI-visits per female vs male Veteran was 11.1 vs 9.8 visits/year, including all settings. Most CMI-related healthcare utilization occurred in primary care. Utilization was consistently higher among females for primary and specialty care settings (including gastroenterology, pain clinics, and rheumatology) and for all 10 years, although differences were less in FY2010-2012.

Implications:
CMI-related ICD-9 diagnoses were twice as prevalent in females and related healthcare utilization was also higher in females compared to males. Whether CMI preferentially brings more female versus male OEF/OIF/OND Veterans into VHA for services, and partly accounts for the higher prevalence, warrants additional research.

Impacts:
Further work is needed to understand reasons for greater CMI-related diagnoses among female versus male OEF/OIF/OND Veterans and may reveal opportunities to provide more tailored approaches to CMI management.