Comparing mental and physical health of U.S. veterans by VA healthcare use: implications for generalizability of research in the VA electronic health records

BMC Health Services Research

Research

Jaimie Gradus¹  Zachary L. Mannes²  Silvia Martins²  Sarah Gutkind²  Katherine M. Keyes²  David S. Fink³  Malka Stohl³  Melanie Wall⁴  Mark Olfson⁴  Dvora Shmulewitz⁴  Deborah S. Hasin⁵  Scott Sherman⁶  Charles Maynard⁷  Andrew J. Saxon⁷  Salomeh Keyhani⁸ 

[1] Boston University School of Public Health, Boston, MA, USA;Columbia University Mailman School of Public Health, New York, NY, USA;New York State Psychiatric Institute, New York, NY, USA;New York State Psychiatric Institute, New York, NY, USA;Columbia University Mailman School of Public Health, New York, NY, USA;New York State Psychiatric Institute, New York, NY, USA;Columbia University Mailman School of Public Health, New York, NY, USA;Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Dr., Unit 123, 10032, New York, NY, USA;New York University, New York, NY, USA;Veteran Affairs, Puget Sound Health Care System, Seattle, WA, USA;University of Washington, Seattle, WA, USA;Veteran Affairs, San Francisco, VA, USA;University of California, San Francisco, CA, USA;

关键词: Generalizability;    Big data;    Electronic health records;    United States Department of Veterans Affairs;    Veterans health;   

DOI  :  10.1186/s12913-022-08899-y

 received in 2022-07-13, accepted in 2022-11-28,  发布年份 2022

来源: Springer

【 摘 要 】

ObjectiveThe Department of Veterans Affairs’ (VA) electronic health records (EHR) offer a rich source of big data to study medical and health care questions, but patient eligibility and preferences may limit generalizability of findings. We therefore examined the representativeness of VA veterans by comparing veterans using VA healthcare services to those who do not.MethodsWe analyzed data on 3051 veteran participants age ≥ 18 years in the 2019 National Health Interview Survey. Weighted logistic regression was used to model participant characteristics, health conditions, pain, and self-reported health by past year VA healthcare use and generate predicted marginal prevalences, which were used to calculate Cohen’s d of group differences in absolute risk by past-year VA healthcare use.ResultsAmong veterans, 30.4% had past-year VA healthcare use. Veterans with lower income and members of racial/ethnic minority groups were more likely to report past-year VA healthcare use. Health conditions overrepresented in past-year VA healthcare users included chronic medical conditions (80.6% vs. 69.4%, d = 0.36), pain (78.9% vs. 65.9%; d = 0.35), mental distress (11.6% vs. 5.9%; d = 0.47), anxiety (10.8% vs. 4.1%; d = 0.67), and fair/poor self-reported health (27.9% vs. 18.0%; d = 0.40).ConclusionsHeterogeneity in veteran sociodemographic and health characteristics was observed by past-year VA healthcare use. Researchers working with VA EHR data should consider how the patient selection process may relate to the exposures and outcomes under study. Statistical reweighting may be needed to generalize risk estimates from the VA EHR data to the overall veteran population.

【 授权许可】

CC BY   
© The Author(s) 2022

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