Evidence Review Identifies Modest Mortality Disparities among Racial and Ethnic Minority Groups in VA Healthcare
Although the Affordable Care Act (ACA) of 2014 has led to significant improvements in healthcare coverage and access, its effects on life expectancy are not yet known. To support VA's efforts to better understand the scale and determinants of disparities in racial and ethnic mortality – and to develop interventions to reduce disparities, investigators from the VA Evidence-based Synthesis Program (ESP) Coordinating Center in Portland, OR conducted an evidence review of mortality disparities specific to VA. This is of particular importance because racial and ethnic diversity is increasing in VA's patient population, with nearly one-quarter of all Veterans coming from racial and ethnic minority groups in FY13. This review provides an update on research and implementation priorities that have emerged since ESP's systematic review on Racial and Ethnic Disparities in the VA Healthcare System (2007) – and its systematic review on Interventions to Improve Minority Health Care and Racial and Ethnic Disparities (2011). Investigators searched MEDLINE® (via PubMed®), and the Cochrane Central Register of Controlled Trials from 10/09/2006 to 02/02/2017, coming up with 2,840 citations, from which they included 25 studies. Studies were large (>e;10,000), involved nationally representative cohorts, and the majority were of fair methodological quality. However, most studies compared mortality between black Veterans and white Veterans only.
- Although VA's equal access healthcare system has reduced many racial/ethnic mortality disparities still present in the private sector, this review identified modest mortality disparities that persist mainly for black Veterans with conditions that include: stage 4 chronic kidney disease, colon cancer, diabetes, HIV, rectal cancer, and stroke.
- There also were modest disparities in mortality for American Indian and Alaska Native Veterans undergoing major non-cardiac surgery, and for Hispanic Veterans with HIV or traumatic brain injury.
- Diabetes was the third most commonly diagnosed condition in racial/ethnic minorities in FY13, thus research into the mortality disparity in Black Veterans with diabetes may have the greatest potential impact.
- Investigators identified few studies for all racial and ethnic minority groups other than black Veterans. Only 21% evaluated Hispanic Veterans, 13% evaluated American Indian and Alaska Native Veterans, 8% evaluated Asian Veterans, and none evaluated Hawaiian or Pacific Islanders.
- Mortality data included in the studies may not include more recent trends (e.g., suicide, opioid use).
- Because most mortality disparities were supported by single studies with imprecise findings, strong conclusions about this evidence could not be drawn.
This study was funded by VA HSR&D's Quality Enhancement Research Initiative (QUERI). All authors are part of HSR&D's Evidence-based Synthesis Program (ESP) Coordinating Center in Portland, OR.
Peterson K, Anderson J, Boundy E, et al. Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map. American Journal of Public Health. March 2018;108(3):e1-e11.