Covid-19 Outcomes Among US Veterans.

Comparing Covid-19 mortality among the U.S. population overall with mortality among Veterans Affairs patients and U.S. military patients.

We read with great interest the article by Purcell, N. et al on the impact of Covid-19 on U.S. veterans’ health and well-being, and how a Whole Health System of Care can help to overcome barriers to the proper care of the veteran population. The authors conducted interviews to gauge the personal, situational, and environmental factors impacting veterans’ pandemic experience. These are important factors that are often not addressed and can have potential major influences on patients’ overall medical care. While this study provided informative qualitative data on Veteran’s wellness during the COVID-19 pandemic, we think it is also important to provide a more quantitative background for these factors and to highlight their importance. Herein we collated data from publicly available government sources[2-5] on the disproportionately poor Covid-19 outcomes affecting our nation’s veterans. The available data is stratified by age and racial groups and by the presence of co-morbidities, making for more granular comparisons between veteran and non-veteran populations. The Department of Veterans Affairs operates the largest integrated healthcare system in the U.S with greater than 9 million veterans enrolled. In the greater than 2 years since the onset of the pandemic, the VA and the US active military have had about 620 000 cases each of Covid-19. However, the number of deaths among the veterans vs active US military personnel are staggeringly unequal, 21 728 (3.5%) vs 683 (.10%) deaths, respectively. Mortality among VA patients is nearly 3-fold higher than the US population and 32-fold higher than younger U.S. military personnel who represent the pre-veteran population. Much of this excess disease burden is attributable to well known risk factors for worse Covid-19 outcomes, including age and chronic morbidities. Among veterans, 37% are over 70 years old compared with 15.2% of the U.S. population. Among veterans 24-64 years old, 30.1% have chronic conditions vs 18.3% of similarly aged U.S. non-veterans. Above 65 years of age, 67% of veterans have chronic conditions vs 60.1% of non-veterans. Specifically, 32.2% and 8.2% of veterans have hypertension and diabetes, respectively, compared to 26% and 7.3% of non-veterans. Among veterans, about 90% are male, 77.3% White, 6.9% Hispanic, 11.8% Black, and 1.6% Asian, compared to U.S. non-veterans of whom 57.8% are White, 18.7% Hispanic, 12.4% Black and 6% Asian.[3-5] The impact of racial demographics on Covid-19 outcomes for veterans is less clear than the age and chronic morbidity comparisons with the U.S. population overall. Lastly, the veteran population is relatively less vaccinated than the U.S. population at large: 66% of veterans vs 77% of the U.S. population have received at least one vaccine dose (as of 4/2022). These data highlight the disproportionate Covid-19 morbidity experienced by Veterans Affairs patients in large part mediated by known risk factors for severe disease and mortality associated with SARS-CoV-2 infection. Veterans’ excess pandemic morbidity and mortality underscore the importance of studies, like Purcell’s, that specifically address veterans’ needs.