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Experiences of Perceived Gender-based Discrimination Among Women Veterans: Data From the ECUUN Study.

MacDonald S, Judge-Golden C, Borrero S, Zhao X, Mor MK, Hausmann LRM. Experiences of Perceived Gender-based Discrimination Among Women Veterans: Data From the ECUUN Study. Medical care. 2020 May 1; 58(5):483-490.

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BACKGROUND: Experiences of discrimination are associated with poor health behaviors and outcomes. Understanding discrimination in health care informs interventions to improve health care experiences. OBJECTIVE: Describe the prevalence of, and variables associated with, perceived gender-based discrimination in the Veterans Affairs (VA) Healthcare System among women Veterans. DESIGN: A cross-sectional, telephone-based survey of a random national sample of young female Veterans. PARTICIPANTS: Female VA primary care patients aged 18-45 years. MAIN MEASURES: The primary outcome was perceived gender-based discrimination in VA health care. Logistic and linear regression models were used to determine associations between any perceived discrimination and cumulative perceived discrimination with patient and health service characteristics. KEY RESULTS: Among 2294 women Veterans, 33.7% perceived gender-based discrimination in VA. Perceiving gender-based discrimination was associated with medical illness [adjusted odds ratio (aOR) = 1.67, 95% confidence interval (CI) = 1.34, 2.08], mental illness (aOR = 2.06, 95% CI = 1.57, 2.69), and military sexual trauma (aOR = 2.65, 95% CI = 2.11, 3.32). Receiving most health care from the same VA provider (aOR = 0.73, 95% CI = 0.57, 0.94) and receiving care at a VA site with a women's health clinic (aOR = 0.76, 95% CI = 0.61, 0.95) were associated with reduced odds of any perceived gender-based discrimination. Among those who perceived gender-based discrimination (n = 733), perceived discrimination scores were higher among women with increased age, medical illness, or history of military sexual trauma and lower among those who saw the same VA provider for most medical care. CONCLUSIONS: One third of women Veterans perceived gender-based discrimination in VA. Obtaining most medical care from the same VA provider and having a women's health clinic at one's VA were associated with less perceived discrimination.

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