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2023 HSR&D/QUERI National Conference Abstract

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4120 — Racial Inequality in Functional Trajectories Between Black and White U.S. Veterans

Lead/Presenter: Courtney Van Houtven ,  COIN - Durham
All Authors: Jacobs JC (Health Economics Resource Center, VA Palo Alto Health Care System), Bowling CB (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center) Brown T (Department of Sociology, Duke University) Smith VA (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center) Decosimo K (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center) Wilson SM (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center) Hastings SN (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center) Shepherd-Banigan M (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center) Allen K (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center) Van Houtven CH (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center)

Objectives:
Racial inequality in functional trajectories has been well documented in the U.S. civilian population but has not been explored among Veterans. We assessed how functional trajectories differed for Black and White Veterans aged ?50 and explored how socioeconomic, psychosocial, and health-related factors altered the relationship between race and functional outcomes.

Methods:
We conducted a prospective, longitudinal analysis using linear mixed effects models. We used stepwise and stratified multivariable models of biannually assessed functional limitations. Data were from the 2006-2016 Health and Retirement Study. Our analytic sample included 3,700 Veterans who were community-dwelling on first observation, who self-identified as Black or White, and who responded to baseline psychosocial questionnaires. Functional trajectory figures were created for each multivariable model based on predicted margins estimated at the mean of other model covariates. Functional limitations were measured as a count of movements with which respondents had difficulty. Race was measured as respondent self-identification as Black or White. Demographic measures included gender and age. Socioeconomic resources included partnership status, education, income, and wealth. Psychosocial stressors included exposure to day-to-day and major discrimination, traumatic life events, stressful life events, and financial strain. Health measures included chronic and mental health diagnoses, smoking, rurality, and use of Veterans Affairs services.

Results:
Black Veterans developed functional limitations at earlier ages and experienced faster functional decline than White Veterans between the ages of 50 and 70. Black Veterans aged 70 had 2.93 (95% CI: 2.65, 3.20) functional limitations versus 2.14 (2.04, 2.24) for White Veterans of the same age. The differences remained statistically significant until age 85, when both Black and White Veterans each had around 5 functional limitations – 5.01 (4.51, 5.52) for Black Veterans and 4.68 (4.53, 4.82) for White Veterans. Black Veterans were significantly more likely than White Veterans to experience all psychosocial stressors (p < 0.001). Once we accounted for economic resources and psychosocial stressors in multivariable analyses, the association between race and the number of functional limitations was no longer statistically significant and the functional trajectories of Black and White Veterans converged. Lower wealth, greater financial strain, and traumatic life events were significantly associated with functional decline for both Black and White Veterans.

Implications:
Health systems should consider how to track Veterans’ function earlier in the life course to ensure that Black Veterans are able to get timely access to services that may slow premature functional decline. Providers may benefit from training about the role of economic resources and psychosocial stressors in physical health outcomes.

Impacts:
This study is the first to demonstrate racial inequality in the functional trajectories of Black and White Veterans aged 50 and older. Our analyses suggest that differential exposure to economic and psychosocial stressors accounts for most of these differences.