Abstract
Purpose: Equal-access health care systems such as the Veterans Health Administration (VHA) reduce financial and nonfinancial barriers to care. It is unknown if such systems mitigate racial/ethnic mortality disparities, such as those well documented in the broader U.S. population. We examined racial/ethnic mortality disparities among VHA health care users, and compared racial/ethnic disparities in VHA and U.S. general populations.Methods: Linking VHA records for an October 2008 to September 2009 national VHA user cohort, and National Death Index records, we assessed all-cause, cancer, and cardiovascular-related mortality through December 2011. We calculated age-, sex-, and comorbidity-adjusted mortality hazard ratios. We computed sex-stratified, age-standardized mortality risk ratios for VHA and U.S. populations, then compared racial/ethnic disparities between the populations.Results: Among VHA users, American Indian/Alaskan Natives (AI/ANs) had higher adjusted all-cause mortality, whereas non-Hispanic Blacks had higher cause-specific mortality versus non-Hispanic Whites. Asians, Hispanics, and Native Hawaiian/Other Pacific Islanders had similar, or lower all-cause and cause-specific mortality versus non-Hispanic Whites. Mortality disparities were evident in non-Hispanic-Black men compared with non-Hispanic White men in both VHA and U.S. populations for all-cause, cardiovascular, and cancer (cause-specific) mortality, but disparities were smaller in VHA. VHA non-Hispanic Black women did not experience the all-cause and cause-specific mortality disparity present for U.S. non-Hispanic Black women. Disparities in all-cause and cancer mortality existed in VHA but not in U.S. population AI/AN men.Conclusion: Patterns in racial/ethnic disparities differed between VHA and U.S. populations, with fewer disparities within VHAs equal-access system. Equal-access health care may partially address racial/ethnic mortality disparities, but other nonhealth care factors should also be explored.
Highlights
Health care access is an important—though not sole— determinant of health outcomes.[1]
Non-Hispanic Blacks had the highest proportion of individuals carrying a diagnosis of SMI (7.5%), whereas Asians had the highest proportion of individuals without a mental health diagnosis (75.3%)
While a nonHispanic Black–non-Hispanic White cancer mortality disparity existed for women in the U.S general population (RR = 1.14, 95% confidence intervals (CIs): 1.13–1.15), there was no statistically significant difference among non-Hispanic Black women Veterans Health Administration (VHA) users (RR = 0.91, 95% CI: 0.73– 1.11)
Summary
Health care access is an important—though not sole— determinant of health outcomes.[1] Racial/ethnic minorities face numerous barriers to accessing health services, including living in communities with fewer primary health care providers[2] and being less likely to have a usual source of care.[3] Equal-access health care systems—. Which strive to eliminate financial barriers to health care—may potentially mitigate well-documented racial/ ethnic mortality disparities in the United States.[4].
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