Wei Duan-Porter1,2, Brian C Martinson3,4,5, Nancy Greer3, Brent C Taylor3,6,5, Kristen Ullman3, Lauren McKenzie3, Christina Rosebush3, Roderick MacDonald3, Samuel Falde6, Timothy J Wilt3,6. 1. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA. wei.duanporter@va.gov. 2. University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA. wei.duanporter@va.gov. 3. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA. 4. HealthPartners Institute, Bloomington, MN, USA. 5. School of Public Health, University of Minnesota, Twin Cities Campus, Minneapolis, MN, USA. 6. University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA.
Abstract
BACKGROUND: Veterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans. METHOD: MEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation. RESULTS: We screened 7242 citations and found 131 eligible articles-99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence). DISCUSSION: Little published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
BACKGROUND: Veterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans. METHOD: MEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation. RESULTS: We screened 7242 citations and found 131 eligible articles-99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence). DISCUSSION: Little published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
Entities:
Keywords:
population health; socioeconomic factors; vulnerable populations
Authors: Jodie G Katon; Keren Lehavot; Tracy L Simpson; Emily C Williams; Sarah Beth Barnett; Joel R Grossbard; Mark B Schure; Kristen E Gray; Gayle E Reiber Journal: Am J Prev Med Date: 2015-06-16 Impact factor: 5.043
Authors: Keren Lehavot; Jodie G Katon; Emily C Williams; Karin M Nelson; Carolyn M Gardella; Gayle E Reiber; Tracy L Simpson Journal: J Womens Health (Larchmt) Date: 2013-12-13 Impact factor: 2.681
Authors: Brie A Williams; James McGuire; Rebecca G Lindsay; Jacques Baillargeon; Irena Stijacic Cenzer; Sei J Lee; Margot Kushel Journal: J Gen Intern Med Date: 2010-06-08 Impact factor: 5.128
Authors: Ann Elizabeth Montgomery; Dorota Szymkowiak; Meagan C Cusack; Erika L Austin; Jesse K Vazzano; Stefan G Kertesz; Sonya Gabrielian Journal: Am J Orthopsychiatry Date: 2019-01-17
Authors: Christian A Betancourt; Panagiota Kitsantas; Deborah G Goldberg; Beth A Hawks Journal: J Behav Health Serv Res Date: 2022-09-29 Impact factor: 1.475
Authors: Allison A Lewinski; Caitlin Sullivan; Kelli D Allen; Matthew J Crowley; Jennifer M Gierisch; Karen M Goldstein; Kaileigh Gray; Susan N Hastings; George L Jackson; Felicia McCant; Abigail Shapiro; Matthew Tucker; Carolyn Turvey; Leah L Zullig; Hayden B Bosworth Journal: J Gen Intern Med Date: 2021-01-26 Impact factor: 6.473
Authors: Elizabeth Ingram; Sarah Ledden; Sarah Beardon; Manuel Gomes; Sue Hogarth; Helen McDonald; David P Osborn; Jessica Sheringham Journal: J Epidemiol Community Health Date: 2020-11-06 Impact factor: 3.710