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2023 HSR&D/QUERI National Conference Abstract

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1125 — Healthcare use by Veteran and Disability Status: Findings from the 2015-2018 National Health Interview Survey

Lead/Presenter: Abigail Mulcahy,  COIN - Portland
All Authors: Mulcahy AC (Center to Improve Veteran Involvement in Care, Portland), Than, C (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles) Chawla, N (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles) Govier, D (Center to Improve Veteran Involvement in Care, Portland) Hoggatt, K (Center for healthcare Improvement & Medical Effectiveness, San Francisco) Yano, E (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles) Hynes, D (Center to Improve Veteran Involvement in Care, Portland)

Objectives:
In the United States (US), Veterans and non-Veterans with disabilities may have access to different healthcare and disability benefits. Few studies have focused on Veterans and disability prevalence and healthcare utilization behavior. We compared the prevalence of different disabilities between Veterans and non-Veterans and examined the relationship between Veteran status, disability status, and healthcare use.

Methods:
We used data from the National Health Interview Survey (NHIS) from 2015 to 2018. The NHIS is one of the longest running data collection programs of the National Center for Health Statistics at the Centers for Disease Control and Prevention and is designed to monitor the health of the non-institutionalized population. Cross-sectional surveys in the NHIS included measures on the number of visits to a health care provider past year, age, sex, race/ethnicity, education, health status, chronic conditions, and Veteran status. Veterans were identified as those who responded “yes” to the question: “Have you ever served on active duty in the U.S. Armed Forces, military reserves, or National Guard?” (yes/no). We constructed variables to represent three disability categories: physical disabilities contained measures related to ambulation, standing, and stooping; social/emotional disabilities contained measures related to the ability to socialize, shop, or relax; and sensory disabilities contained measures related to difficulty hearing and seeing. We used crosstabulations to compare summary statistics across groups and ordered logistic regression to examine Veteran and disability status on healthcare utilization (defined as the number of office visits) in the past year (0,1,2-5, 6-9, 10+ visits).

Results:
Of the 118,859 participants, 10% were Veterans. Veterans were predominantly male and white race. Veterans were older compared to non-Veterans with 49% of Veterans versus 17% of non-Veterans aged 65 and older. Veterans and non-Veterans were similar in terms of level of education and income; Veterans compared to non-Veterans, reported higher levels of physical disability (52% versus 35%, respectively), social/emotional disabilities (17% versus 12%, respectively), and sensory disabilities (49% compared to 27%, respectively). In preliminary adjusted analyses, Veterans status and disability status were positively associated with healthcare use.

Implications:
We observed systematic differences in healthcare use between US Veterans and non-Veterans with and without disabilities. Veterans and those with disabilities were more likely to use more healthcare. These findings suggest that there may be greater healthcare need as well as facilitators in access to healthcare for Veterans and those with disabilities.

Impacts:
The findings from this study are relevant both to VA health systems as well as Centers for Medicare and Medicaid Services and have the potential to inform not only health systems policy but public policy related to disability and healthcare use in Veteran and non-Veteran populations.