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.