Duty, Honor, Country, Disparity: Race/Ethnic Differences in Health and Disability Among Male Veterans

Abstract

Given their unique occupational hazards and sizable population, military veterans are an important population for the study of health. Yet veterans are by no means homogeneous, and there are unanswered questions regarding the extent of, and explanations for, racial and ethnic differences in veterans’ health. Using the 2010 National Survey of Veterans, we first documented race/ethnic differences in self-rated health and limitations in Activities of Daily Living among male veterans aged 30–84. Second, we examined potential explanations for the disparities, including socioeconomic and behavioral differences, as well as differences in specific military experiences. We found that Black, Hispanic, and other/multiple race veterans reported much worse health than White veterans. Using progressively adjusted regression models, we uncovered that the poorer self-rated health and higher levels of activity limitations among minority veterans compared to Whites was partially explained by differences in their socioeconomic status and by their military experiences. Minority veterans are a vulnerable population for poor health; future research and policy efforts should attempt to better understand and ameliorate their health disadvantages relative to White veterans.

US Military Service and Racial/Ethnic Differences in Cardiovascular Disease: An Analysis of the 2011-2016 Behavioral Risk Factor Surveillance System

“…in self-reported health. 15 Findings from this analysis showed that socioeconomic factors related to military experience (including combat exposure and age of enlistment) and smoking behavior, all contributed to racial/ ethnic differences in overall health.…”

“…These findings are consistent with a previous analysis of the 2010 National Survey of Veterans, which found that racial/ethnic disparities in self-rated health and disability among veterans could be partially explained by socioeconomic factors and smoking behavior. 15 The contribution of physical activity was 4.3% for non-Hispanic Blacks and 4.1% for Hispanics, but was only .9% for non-Hispanic Whites, and even less for Other race/ ethnicity. This was largely driven by the fact that there was no difference in the percentage of non-Hispanic Whites and Other race/ethnicity with prior military service and no prior military service who engaged in physical activity in the past 30 days, while physical activity was 7% higher for non-Hispanic Black military veterans than non-veterans, and 15% higher for Hispanic military veterans than non-veterans.…”

“…11 While racial/ethnic disparities in the civilian population have been established, 12,13 less is known about CVD outcomes in the military and veteran population. Previous studies on racial/ ethnic disparities within the military population have found that Black and Hispanic service members and veterans have reported poorer outcomes Military Service, Race/Ethnicity, and CVD -Walker et al when compared with Whites, 14,15 with higher rates of hypertension and diabetes, 14 lower self-rated health 15 and, among Black service members, higher rates of obesity. 16 However, there is also evidence that CVD mortality among Black veterans may be similar or lower to that of White veterans.…”

Editors’ Introduction

“…Because eligibility for VA services and veterans' health care coverage is partially determined by having a service-connected disability or meeting means-tested standards for indigence, however, this suggests that issues of selection partially govern the observed disparities in health outcomes. These findings also signal an important insight into policy-linked questions about both military enlistment and public provision of health care, and contribute to an active debate on how pre-selection characteristics, cohort of service, and experiences while in uniform might drive observed differences in health outcomes (see, e.g., Conley and Heerwig 2012;MacLean and Edwards 2010;Mohamed et al 2009;Rackin 2017;Sheehan et al 2015;Teachman 2010).…”

A national benchmark investigation of return-to-work outcome rates between African American, Native American or Alaskan Native, Latino, Asian American or Pacific Islander, and Non-Latino White veterans served by state vocational rehabilitation agencies: Application of bootstrap data expansion

“…Combat related disabilities oftentimes result in self-care limitations, difficulty with independent living, and work limitations (Tennant, 2012;Twamley et al, 2014). African American and Latino veterans report significantly greater odds of disability when compared to non-Latino White veterans (Sheehan et al, 2012). They are also more likely to develop PTSD; Asian veterans have higher rates of diagnosed schizophrenia; and Native American Vietnam War era veterans still experienced PTSD more than 25 years after that war (National Alliance on Mental Illness, 2014).…”