Disparities in Excess, All-Cause Mortality among Black, Hispanic, and White Veterans at the U.S. Department of Veterans Affairs during the COVID-19 Pandemic

Lukowsky, Lilia R.; Der‐Martirosian, Claudia; Dobalian, Aram

doi:10.3390/ijerph19042368

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…Due to the unique demographic characteristics of this population, questions have been raised about the relevance of studies in this population. Previous reports show that death rates among those who typically received care in the VA health system were less affected than death rates among the general US population during the COVID-19 pandemic, despite higher rates of comorbidities in the veteran population . However, veterans enrolled in VA health care also differ from the general US population in age, sex, racial and ethnic composition, and geographic distribution, and each of these factors has been associated with mortality rates in general and death rates due to COVID-19 specifically .…”

Section: Introductionmentioning

confidence: 99%

Excess Mortality Among Patients in the Veterans Affairs Health System Compared With the Overall US Population During the First Year of the COVID-19 Pandemic

Rose

Rentsch

Asch³

et al. 2023

JAMA Netw Open

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ImportanceDuring the first year of the COVID-19 pandemic, there was a substantial increase in the rate of death in the United States. It is unclear whether those who had access to comprehensive medical care through the Department of Veterans Affairs (VA) health care system had different death rates compared with the overall US population.ObjectiveTo quantify and compare the increase in death rates during the first year of the COVID-19 pandemic between individuals who received comprehensive medical care through the VA health care system and those in the general US population.Design, Setting, and ParticipantsThis cohort study compared 10.9 million enrollees in the VA, including 6.8 million active users of VA health care (those with a visit in the last 2 years), with the general population of the US, with deaths occurring from January 1, 2014, to December 31, 2020. Statistical analysis was conducted from May 17, 2021, to March 15, 2023.Main Outcomes and MeasuresChanges in rates of death from any cause during the COVID-19 pandemic in 2020 compared with previous years. Changes in all-cause death rates by quarter were stratified by age, sex, race and ethnicity, and region, based on individual-level data. Multilevel regression models were fit in a bayesian setting. Standardized rates were used for comparison between populations.ResultsThere were 10.9 million enrollees in the VA health care system and 6.8 million active users. The demographic characteristics of the VA populations were predominantly male (&gt;85% in the VA health care system vs 49% in the general US population), older (mean [SD], 61.0 [18.2] years in the VA health care system vs 39.0 [23.1] years in the US population), and had a larger proportion of patients who were White (73% in the VA health care system vs 61% in the US population) or Black (17% in the VA health care system vs 13% in the US population). Increases in death rates were apparent across all of the adult age groups (≥25 years) in both the VA populations and the general US population. Across all of 2020, the relative increase in death rates compared with expected values was similar for VA enrollees (risk ratio [RR], 1.20 [95% CI, 1.14-1.29]), VA active users (RR, 1.19 [95% CI, 1.14-1.26]), and the general US population (RR, 1.20 [95% CI, 1.17-1.22]). Because the prepandemic standardized mortality rates were higher in the VA populations prior to the pandemic, the absolute rates of excess mortality were higher in the VA populations.Conclusions and RelevanceIn this cohort study, a comparison of excess deaths between populations suggests that active users of the VA health system had similar relative increases in mortality compared with the general US population during the first 10 months of the COVID-19 pandemic.

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Section: Introductionmentioning

confidence: 99%

Excess Mortality Among Patients in the Veterans Affairs Health System Compared With the Overall US Population During the First Year of the COVID-19 Pandemic

Rose

Rentsch

Asch³

et al. 2023

JAMA Netw Open

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“…In particular, the existing work found that excess mortality was highest for Hispanic Veterans (34%), followed by Black Veterans (32%). 18 Our estimates suggest that excess mortality was highest for Native American Veterans (40%) followed by Black (32%) and Hispanic Veterans (26%), respectively.…”

Section: Discussionmentioning

confidence: 70%

“…Prior work found a 16.7% overall rate of excess mortality for all Veterans, and minoritized Veterans experienced higher rates of excess mortality compared to White Veterans in simple comparisons. 18 , 19 This existing work, however, was limited in scope by focusing on a narrow cohort of Veterans over a short period of time, with no ability to account for comorbidities that may increase the risk of death during the COVID‐19 pandemic. We extend these existing works and leverage a rigorous, previously‐validated approach to identify excess mortality attributable to COVID‐19 stratified by race and ethnicity.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, it is critical to understand how they may have been uniquely impacted by the COVID‐19 pandemic. Prior work found a 16.7% overall rate of excess mortality for all Veterans, and minoritized Veterans experienced higher rates of excess mortality compared to White Veterans in simple comparisons 18,19 . This existing work, however, was limited in scope by focusing on a narrow cohort of Veterans over a short period of time, with no ability to account for comorbidities that may increase the risk of death during the COVID‐19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

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Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID‐19 pandemic

Feyman

Avila

Auty

et al. 2022

Health Services Research

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Objective The COVID‐19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all‐cause mortality during the COVID‐19 pandemic, stratified by race and ethnicity. Data Sources Administrative data from the Veterans Health Administration's Corporate Data Warehouse. Study Design We use pre‐pandemic data to estimate mortality risk models using five‐fold cross‐validation and quasi‐Poisson regression. Models were stratified by a combined race‐ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. Data Collection We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016–2020. Veterans were excluded from analyses if they were missing county of residence or race‐ethnicity data. Data were then aggregated to the county‐year level and stratified by race‐ethnicity. Principal Findings Overall, Veterans' mortality rates were 16% above normal during March–December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non‐Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%–24%), while Native American Veterans had the highest increase (40%, 95% CI 17%–73%). Black Veterans (32%, 95% CI 27%–39%) and Hispanic Veterans (26%, 95% CI 17%–36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. Conclusions Minoritized Veterans experienced higher rates excess of mortality during the COVID‐19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long‐standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.

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“…Previous reports show that death rates among those who typically received care in the VA system were less affected than the general US population during the COVID-19 pandemic, despite higher rates of comorbidities [5][6][7]. However, Veterans enrolled in VA care also differ from the general US population in age, sex, racial/ethnic composition, and geographic distribution, and each of these factors has been associated with mortality rates in general and deaths rates due to COVID-19 specifically [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Excess mortality in the general population versus Veterans Healthcare System during the first year of the COVID-19 pandemic in the United States

Rose

Rentsch

Asch

et al. 2022

Preprint

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Importance The COVID-19 pandemic had a substantial impact on the overall rate of death in the United States during the first year. It is unclear whether access to comprehensive medical care, such as through the VA healthcare system, altered death rates compared to the US population. Objective: Quantify the increase in death rates during the first year of the COVID-19 pandemic in the general US population and among individuals who receive comprehensive medical care through the Department of Veterans Affairs (VA). Design: Analysis of changes in all-cause death rates by quarter, stratified by age, sex race/ethnicity, and region, based on individual-level data. Hierarchical regression models were fit in a Bayesian setting. Standardized rates were used for comparison between populations. Setting and participants: General population of the United States, enrollees in the VA, and active users of VA healthcare. Exposure and main outcome: Changes in rates of death from any cause during the COVID-19 pandemic in 2020 compared to previous years. Results Sharp increases were apparent across all of the adult age groups (25 years and older) in both the general US population and the VA populations. Across all of 2020, the relative increase in death rates was similar in the general US population (RR: 1.20 (95% CI: 1.17, 1.22)), VA enrollees (RR: 1.20 (95% CI: 1.14, 1.29)), and VA active users (RR: 1.19 (95% CI: 1.14, 1.26)). Because the pre-pandemic standardized mortality rates were higher in the VA populations prior to the pandemic, the absolute rates of excess mortality were higher in the VA populations. Conclusions and Relevance: Despite access to comprehensive medical care, active users of the VA had similar relative mortality increases from all causes compared with the general US population. Factors that influenced baseline rates of death and that mitigated viral transmission in the community are more likely to have influenced the impact of the pandemic.

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Disparities in Excess, All-Cause Mortality among Black, Hispanic, and White Veterans at the U.S. Department of Veterans Affairs during the COVID-19 Pandemic

Cited by 7 publications

References 24 publications

Excess Mortality Among Patients in the Veterans Affairs Health System Compared With the Overall US Population During the First Year of the COVID-19 Pandemic

Excess Mortality Among Patients in the Veterans Affairs Health System Compared With the Overall US Population During the First Year of the COVID-19 Pandemic

Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID‐19 pandemic

Excess mortality in the general population versus Veterans Healthcare System during the first year of the COVID-19 pandemic in the United States

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