Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4086 — Evolving Profile of Women and Men Veterans in VHA, FY00 to FY15

Lead/Presenter: Fay Saechao, COIN - Palo Alto
All Authors: Saechao FS (HSR&D Center for Innovation to Implementation (Ci2i), Palo Alto, CA) Hayes PM (Women’s Health Services, VA Central Office, Washington, DC) Haskell S (Women’s Health Services, VA Central Office, Washington, DC; VA Connecticut Health Care System; Yale University School of Medicine) Berg E (Ci2i) Lee J (Ci2i) Phibbs CS (Ci2i; Stanford University School of Medicine, Palo Alto, CA) Iqbal S (Women’s Health Section, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA) Frayne SM (Ci2i; Stanford University School of Medicine, Palo Alto, CA)

Objectives:
Meeting the needs of women Veterans (WVs), one of the Veterans Health Administration's (VHA's) fastest growing subgroups, is a high priority for VHA. We sought to identify how characteristics of WV VHA patients change over time, benchmarked against men Veterans (MV).

Methods:
In cross-sectional analyses at four time points (Fiscal Year [FY] 2000, 2005, 2010, 2015), we examined sociodemographic characteristics of all VHA patients nationally, stratified on gender. Using VHA administrative data and applying established algorithms, we described trends in distribution of age, race/ethnicity, and service-connected (SC) disability over the 15-year period.

Results:
In FY2000, 159,810 WVs (4.7% of 3,386,123 patients), sought VHA care. By FY2015, the number nearly tripled to 439,791 (7.5% of 5,890,074 patients). Over the 15-year period, middle age (45-64 years) Veterans grew markedly among women (from 29.7% to 45.9%) but declined in men (from 39.6% to 31.9%). Conversely, proportions of young and older Veterans decreased among women (18-44: from 51.2% to 42.6%; 65+: from 19.1% to 11.6%) but increased in men (18-44: from 13.9% to 15.2%; 65+: from 46.5% to 52.9%). The racial/ethnic diversity of Veterans increased more rapidly among WVs than MVs: non-White groups increased from 30.3% to 41.5% among WVs but only from 21.8% to 24.7% among MVs. Among WVs, growth was greatest in the Hispanic subgroup (from 3.1% to 7.1%). The proportion with any SC disability increased more in WVs (from 48.3% to 63.2%) than in MVs (from 39.1% to 51.8%).

Implications:
The number of WVs in VHA nearly tripled from FY2000 to FY2015. Women remained substantially younger than men, but the proportion of middle age WVs expanded rapidly, as did WVs' racial/ethnic diversity and SC disability over the 15-year period.

Impacts:
To meet the needs of the growing WV population, VHA must consider intersectionality of WVs' characteristics (e.g., interactions of gender, race/ethnicity, and age) and their evolving clinical profiles; for example, chronic disease management may become an increasing need as the large 45-64 year old population ages. Gender-tailored services likely will require adaptation over time to meet the dynamic needs of this heterogeneous population.