Men and women have different health and healthcare concerns, illustrated by results of the 2013 Kaiser Men's Health Survey and Women's Health Survey of a nationally representative sample of men and women ages 18 to 64. Findings show that 68% of men compared to 81% of women identified a clinician they see for routine care, and women were more likely than men to have seen a provider in the past two years (91% vs. 75%). Men and women reported fair and poor health at similar rates (17% vs. 15%); however, significantly more women reported having an ongoing condition that requires regular monitoring (43% vs. 30%), and more women than men (26% vs. 20%) reported having to delay or forgo care in the past year due to cost.1
In 2008, VA began a national initiative to eliminate gender gaps in preventive care, and in 2011, VA asked its healthcare regions across the country to review gender disparity data and to create and implement an improvement plan. A subsequent report released by VA's Office of Informatics and Analytics shows that VA has improved gender disparities in several key areas, including screening for PTSD, depression, and colorectal cancer, as well as improving chronic disease management for women Veterans with hypertension, diabetes, and hyperlipidemia, all risk factors for heart disease. In addition, the Women Veterans Health Strategic Health Care Group leads an initiative to improve care for women Veterans, and issued a report identifying best practices for eliminating gender gaps based on success in VA networks.
Gender differences in healthcare also apply to the transgender community. The umbrella term "transgender" has been used as a descriptor (not a diagnosis) for those who experience incongruity between birth sex and subjective sense of gender, and who may or may not meet the diagnostic criteria for a disorder. In 2011, the Veterans Health Administration Transgender Healthcare Directive was issued to all of its facilities establishing a policy of respectful delivery of healthcare to transgender and intersex Veterans enrolled in VA healthcare.
Following are descriptions of just a few select studies that HSR&D and QUERI investigators conduct on gender, including transgender, differences in healthcare.
Pain and its impact on physical and emotional functioning have been associated with prior traumatic experiences, low levels of social support, and higher levels of conflict. Notably, gender differences in traumatic exposure, social support, and interpersonal conflict have been observed among Veterans. Thus, this study examined a) gender differences in trauma, social support, and family conflict among Veterans with chronic pain, and b) whether these variables were differentially associated with pain severity, functioning, and depressive symptom severity as a function of gender. Using data from the Women Veterans Cohort Study survey, investigators studied male and female Veterans who served in Iraq and/or Afghanistan, who were enrolled in VA healthcare between 9/01 and 9/12 - and who endorsed having pain for three months or longer. Self-report measures included: pain severity, functioning, depressive symptom severity, opioid use, exposure to traumatic life events, emotional and tangible support, and family conflict. Findings show:
Gender may be a salient target of investigation when examining development of and/or adaptation to chronic pain, and is an important consideration in tailoring treatment programs to meet the needs of Veterans with chronic pain.
Driscoll M, Higgins D, Seng E, et al. Trauma, social support, family conflict, and chronic pain in recent Veterans: What does gender matter? Pain Medicine. April 30, 2015; Epub ahead of print.
Research about transgender persons and their healthcare concerns or outcomes has been limited largely to sources outside healthcare systems, and the majority of those who participate in such studies are white. As part of a comprehensive research program undertaken by VA's Office of Health Equity to assess health disparities among transgender Veterans, this study examined racial disparities in the prevalence of psychiatric and medical conditions among these Veterans. Using VA data, investigators identified 4,507 transgender Veterans: 4,120 non-Hispanic whites and 387 African Americans who sought VA healthcare between FY1996 and FY2013. Measures included: demographics; social determinants of health (e.g., rural residence, homelessness); service-related characteristics (e.g., service-connected disability, combat status); and mental health and medical illness, including alcohol and substance abuse. Findings show:
These findings may have implications for policy, prevention strategies, and healthcare delivery in VA and other healthcare systems.
Brown GR and Jones KT. Racial health disparities in a cohort of 5,135 transgender Veterans. Journal of Racial and Ethnic Health Disparities. December 2014;1(4):257-266.
Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans are at risk for a variety of post-deployment mental health problems, including PTSD, depression, and alcohol abuse. Along with access to care issues, one of the most important factors that may drive mental health service use among Veterans is their attitude about VA healthcare and mental illness in general. This study explored gender differences in attitudinal barriers to and facilitators of care for OEF/OIF Veterans, and determined the relationship of those factors to VA mental health service use among female and male Veterans with probable mental health conditions. From a national sample, investigators identified 278 OEF/OIF Veterans (164 women and 114 men) with a probable diagnosis of PTSD, depression, or alcohol abuse, who had returned from deployment to Iraq or Afghanistan between 2007 and 2009 - and were separated from service at study time. Study measures assessed mental health symptomatology, positive perceptions of VA care, perceived fit in the VA setting, beliefs about mental illness and treatment, and use of VA mental healthcare in the past six months. Findings show:
Fox A, Meyer E, and Vogt D. Attitudes about the VA healthcare setting, mental illness, and mental health treatment and their relationship with VA mental health service use among female and male OEF/OIF Veterans. Psychological Services. February 2015;12(1):49-58.
Approximately 700,000 people in the U.S. identify as transgender; these individuals may experience symptoms of gender dysphoria and are at increased risk for depression, suicidal behavior, binge drinking, substance abuse, interpersonal violence, and cardiovascular disease. Starting in 2007, VA facilities enacted a range of policies regarding transgender care and, in June 2011, issued a national Directive to standardize treatment services for transgender Veterans. This study examined the incidence of an expanded set of ICD-9 encounter codes before and after the Directive was issued. Using VA data, investigators identified all VA clinical encounters from FY06 through FY13 for Veterans with an ICD-9 code of Gender Identity Disorder (GID), GID not otherwise specified, or Transsexualism. Additional transgender Veterans might be receiving VA care and not have one of these diagnoses or codes. Findings show:
The authors suggest that transgender Veterans are increasingly likely to be identified and better able to access transgender-related care within the VA healthcare system.
Kauth M, Shipherd J, Lindsay J, et al. Access to care for transgender Veterans in VHA: 2006-2013. American Journal of Public Health. September 2014;104(Suppl 4):S532-S534.
Gender disparities in the use of high-intensity statin therapy in patients with cardiovascular disease (CVD) are not known. Therefore, this study sought to identify the proportion of male (n=959,161) and female (n=13,371) Veterans with CVD who received care in any of 130 VA facilities between October 1, 2010 and September 30, 2011, and who received any statin and high-intensity statin. CVD patients were those with a history of coronary heart disease, peripheral artery disease, or ischemic stroke. Using VA pharmacy data, investigators determined whether these Veterans were prescribed a statin or a high-intensity statin within 100 days prior to - or 14 days following their index visit. Demographics and history of diabetes or hypertension also were assessed. Findings show:
With the "statin dose-based approach" proposed by the recent cholesterol guidelines, these results highlight areas for quality improvement. It is important to note that despite the observed gender disparity in this study, statin and high-intensity statin use remain low in both genders.
Virani S, Woodard L, Ramsey D, et al. Gender differences in evidence-based statin therapy in patients with cardiovascular disease. American Journal of Cardiology. January 1, 2015;115(1):21-26.
1. The Henry J. Kaiser Family Foundation. Gender Differences in Health Care, Status, and Use. March 31, 2015.