Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

HSR&D Citation Abstracts

Search | Search by Center | Search by Source | Keywords in Title

Shaw JG, Joyce VR, Schmitt SK, Frayne SM, Shaw KA, Danielsen B, Kimerling R, Asch SM, Phibbs CS. Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data. Health services research. 2018 Dec 1; 53 Suppl 3:5260-5284.
PubMed logo Search for Abstract from PubMed
(This link leaves the website of VA HSR&D.)


Abstract: OBJECTIVE: To describe variation in payer and outcomes in Veterans' births. DATA/SETTING: Secondary data analyses of deliveries in California, 2000-2012. STUDY DESIGN: We performed a retrospective, population-based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (VA) enrollment records), to identify payer and variations in outcomes among: (1) Veterans using VA coverage and (2) Veteran vs. all other births. We calculated odds ratios (aOR) adjusted for age, race, ethnicity, education, and obstetric demographics. METHODS: We anonymously linked VA administrative data for all female VA enrollees with California birth records. PRINCIPAL FINDINGS: From 2000 to 2012, we identified 17,495 births to Veterans. VA covered 8.6 percent (1,508), Medicaid 17.3 percent, and Private insurance 47.6 percent. Veterans who relied on VA health coverage had more preeclampsia (aOR 1.4, CI 1.0-1.8) and more cesarean births (aOR 1.2, CI 1.0-1.3), and, despite similar prematurity, trended toward more neonatal intensive care (NICU) admissions (aOR 1.2, CI 1.0-1.4) compared to Veterans using other (non-Medicaid) coverage. Overall, Veterans' birth outcomes (all-payer) mirrored California's birth outcomes, with the exception of excess NICU care (aOR 1.15, CI 1.1-1.2). CONCLUSIONS: VA covers a higher risk fraction of Veterans' births, justifying maternal care coordination and attention to the maternal-fetal impacts of Veterans' comorbidities.