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LaVela SL, Smith B, Weaver FM, Miskevics SA. Geographical proximity and health care utilization in veterans with SCI&D in the USA. Social science & medicine. 2004 Dec 1; 59(11):2387-99.
In the USA, substantial geographic variation in health care utilization exists in the Department of Veterans Affairs (VA) health care system. Utilization of health care services is especially important for veterans with spinal cord injuries and disorders (SCIandD) who are often at high risk for secondary complications related to their SCIandD. Due to impaired mobility, access to health care for veterans with SCIandD may be even more challenging. The goal of this cross-sectional study was to describe health care utilization relative to SCIandD veteran residential geographic proximity to VA health care facilities. A negative binomial regression model was used to examine VA outpatient utilization. Veterans with SCIandD utilized outpatient services less frequently when VA facilities were farther away from their residences (p < 0.000). Female (p < 0.000), older (p < 0.000), and non-white veterans (p < 0.000), and veterans with history of respiratory (p < 0.000), kidney/urinary tract (p < 0.005), circulatory (p < 0.000), or digestive system diseases (p < 0.003) were more likely to utilize outpatient care during the study period. A Poisson model was used to examine inpatient utilization. Inpatient utilization decreased when travel distance to VA facility increased (p < 0.000). Contrary to outpatient, age did not significantly affect veterans' likelihood of using inpatient health care. Marital status, gender, race, and level of injury were not related to inpatient utilization. However, history of prior illnesses including respiratory (p < 0.000), kidney/urinary tract (p < 0.000), circulatory (p < 0.005), digestive system (p < 0.015), or skin/subcutaneous tissue/breast-related illnesses (p < 0.000) were associated with a greater likelihood of inpatient utilization. Geographic proximity and other factors on health care use must be considered in order to meet the health care demand patterns of veterans with SCIandD.