Mortality Among Veterans and Non-veterans: Does Type of Health Care Coverage Matter?

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Abstract

Recent studies examine veteran status differences in mortality, but none consider heterogeneity in military-veteran health care coverage. We use data from the 1997–2009 (2011) National Health Interview Survey-Linked Mortality Files (N = 624,610) to estimate Cox regression models of the association between veteran status and mortality taking into account the type of military-veteran health care coverage and sex/gender. Descriptive analyses provide further evidence that veterans who only use Veterans Affairs (VA) health care services are a distinctly disadvantaged subpopulation with substantially increased mortality risk. Results from multivariate analyses confirm a veteran mortality disadvantage, reveal that this disadvantage varies by type of military-veteran health coverage, and demonstrate that the disadvantage is largely but not totally explained by demographic, socioeconomic, and health status differences between groups. Results further indicate that the veteran mortality disadvantage is most pronounced among male veterans who only use VA health care or who have no military-veteran health coverage, respectively, relative to male non-veterans with no military-veteran health care coverage. There is a mortality disadvantage among female veterans who have no military-veteran health care coverage, and a mortality advantage among female non-veterans with military-veteran health care coverage, relative to female non-veterans with no military-veteran health care. Based on these findings, we argue that in order to fully understand veteran status differences in morbidity and mortality, future studies must move beyond the analysis of veteran- and VA-only samples, and should take into account variable connections of subpopulations to the military, resultant differences in types of health care coverage, and sex/gender.

Original languageEnglish (US)
Pages (from-to)1-21
Number of pages21
JournalPopulation Research and Policy Review
DOIs
StateAccepted/In press - Apr 23 2018

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health care
mortality
coverage
Military
subpopulation
gender
health
mortality risk
health survey
socioeconomic status
health status
morbidity
health care services
social status
regression
interview
evidence

Keywords

  • Gender
  • Military-veteran health care
  • Mortality
  • Socioeconomic status
  • Veteran

ASJC Scopus subject areas

  • Demography
  • Management, Monitoring, Policy and Law

Cite this

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title = "Mortality Among Veterans and Non-veterans: Does Type of Health Care Coverage Matter?",
abstract = "Recent studies examine veteran status differences in mortality, but none consider heterogeneity in military-veteran health care coverage. We use data from the 1997–2009 (2011) National Health Interview Survey-Linked Mortality Files (N = 624,610) to estimate Cox regression models of the association between veteran status and mortality taking into account the type of military-veteran health care coverage and sex/gender. Descriptive analyses provide further evidence that veterans who only use Veterans Affairs (VA) health care services are a distinctly disadvantaged subpopulation with substantially increased mortality risk. Results from multivariate analyses confirm a veteran mortality disadvantage, reveal that this disadvantage varies by type of military-veteran health coverage, and demonstrate that the disadvantage is largely but not totally explained by demographic, socioeconomic, and health status differences between groups. Results further indicate that the veteran mortality disadvantage is most pronounced among male veterans who only use VA health care or who have no military-veteran health coverage, respectively, relative to male non-veterans with no military-veteran health care coverage. There is a mortality disadvantage among female veterans who have no military-veteran health care coverage, and a mortality advantage among female non-veterans with military-veteran health care coverage, relative to female non-veterans with no military-veteran health care. Based on these findings, we argue that in order to fully understand veteran status differences in morbidity and mortality, future studies must move beyond the analysis of veteran- and VA-only samples, and should take into account variable connections of subpopulations to the military, resultant differences in types of health care coverage, and sex/gender.",
keywords = "Gender, Military-veteran health care, Mortality, Socioeconomic status, Veteran",
author = "Scott Landes and London, {Andrew S} and Wilmoth, {Janet M}",
year = "2018",
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doi = "10.1007/s11113-018-9468-2",
language = "English (US)",
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T2 - Does Type of Health Care Coverage Matter?

AU - Landes, Scott

AU - London, Andrew S

AU - Wilmoth, Janet M

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N2 - Recent studies examine veteran status differences in mortality, but none consider heterogeneity in military-veteran health care coverage. We use data from the 1997–2009 (2011) National Health Interview Survey-Linked Mortality Files (N = 624,610) to estimate Cox regression models of the association between veteran status and mortality taking into account the type of military-veteran health care coverage and sex/gender. Descriptive analyses provide further evidence that veterans who only use Veterans Affairs (VA) health care services are a distinctly disadvantaged subpopulation with substantially increased mortality risk. Results from multivariate analyses confirm a veteran mortality disadvantage, reveal that this disadvantage varies by type of military-veteran health coverage, and demonstrate that the disadvantage is largely but not totally explained by demographic, socioeconomic, and health status differences between groups. Results further indicate that the veteran mortality disadvantage is most pronounced among male veterans who only use VA health care or who have no military-veteran health coverage, respectively, relative to male non-veterans with no military-veteran health care coverage. There is a mortality disadvantage among female veterans who have no military-veteran health care coverage, and a mortality advantage among female non-veterans with military-veteran health care coverage, relative to female non-veterans with no military-veteran health care. Based on these findings, we argue that in order to fully understand veteran status differences in morbidity and mortality, future studies must move beyond the analysis of veteran- and VA-only samples, and should take into account variable connections of subpopulations to the military, resultant differences in types of health care coverage, and sex/gender.

AB - Recent studies examine veteran status differences in mortality, but none consider heterogeneity in military-veteran health care coverage. We use data from the 1997–2009 (2011) National Health Interview Survey-Linked Mortality Files (N = 624,610) to estimate Cox regression models of the association between veteran status and mortality taking into account the type of military-veteran health care coverage and sex/gender. Descriptive analyses provide further evidence that veterans who only use Veterans Affairs (VA) health care services are a distinctly disadvantaged subpopulation with substantially increased mortality risk. Results from multivariate analyses confirm a veteran mortality disadvantage, reveal that this disadvantage varies by type of military-veteran health coverage, and demonstrate that the disadvantage is largely but not totally explained by demographic, socioeconomic, and health status differences between groups. Results further indicate that the veteran mortality disadvantage is most pronounced among male veterans who only use VA health care or who have no military-veteran health coverage, respectively, relative to male non-veterans with no military-veteran health care coverage. There is a mortality disadvantage among female veterans who have no military-veteran health care coverage, and a mortality advantage among female non-veterans with military-veteran health care coverage, relative to female non-veterans with no military-veteran health care. Based on these findings, we argue that in order to fully understand veteran status differences in morbidity and mortality, future studies must move beyond the analysis of veteran- and VA-only samples, and should take into account variable connections of subpopulations to the military, resultant differences in types of health care coverage, and sex/gender.

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