Health care is distributed unevenly in the United States, and minority populations often receive less care than others, or care of lesser quality.
The majority of Veterans today are predominantly male and white, with the largest cohort having served during the Vietnam War. Over the next 25 years, however, as Gulf War Veterans overtake Vietnam Veterans as the largest group, the percentage of white male Veterans is set to decline by nearly 48 percent.
Meanwhile, the percentage of several other groups—women, African Americans, Hispanics, and other non-white Veterans—will increase. By 2040, women will make up nearly 20 percent of the Veteran population, and 34 percent of all Veterans will be nonwhite.
One implication of some of these trends and others is that American Veterans are increasingly from populations the federal government considers to be "potentially vulnerable patient populations." Veterans from these groups are at risk of receiving lower-quality medical care or for having worse medical outcomes than patients from the majority.
Members of minority communities have higher rates of chronic illnesses such as diabetes and hypertension. According to the Centers for Disease Control and Prevention (CDC), 42 percent of adult blacks are hypertensive, compared to 28.8 percent of whites—and levels of control of hypertension are lowest for Mexican Americans. CDC also reported that 7.0 percent of adult white Americans are diabetic, compared to 11 percent of blacks, 10.2 percent of Hispanics, and 8.2 percent of Asian Americans.
Minorities also have higher rates of many cancers and tend to get diagnosed at later stages, when those illnesses are harder to treat. In 2015, the National Cancer Institute estimated the death rate from all cancers is 25 percent higher for blacks than for whites.
There are no simple reasons for these disparities, and no simple solutions. Health care access is important, but it is not the only factor. Income, education, social context and support, life experience, perceived discrimination, and patient-level preferences may also contribute. Provider and health care system factors may also play a role.
As the nation's largest health care system, VA offers a unique opportunity to understand the complex reasons why health care disparities may occur. VA also offers an ideal setting in which to develop and evaluate patient-centered and culturally sensitive approaches to care.
VA researchers improve the lives of Veterans by identifying disparities in health care between populations of Veterans, understanding the factors that may underlie these differences, and developing and testing ways to reduce and eliminate them.
One of the nation's premier research sites for such work is the Center for Health Equity Research and Promotion (CHERP), supported mainly by VA's Health Services Research and Development (HSR&D) service. CHERP has investigators at both the Pittsburgh and Philadelphia VA medical centers.
In 2007, the Evidence-Based Synthesis Program, sponsored by VA Health Services Research and Development (HSR&D), systematically reviewed existing evidence on disparities within VA to determine the clinical areas in which disparities were present and to describe what was known about the sources of these disparities.
Researchers with the CHERP created a conceptual framework that outlined three phases of health disparities research: detection, understanding, and reduction and elimination.
Detection means acquiring the knowledge that disparities exist, typically discovered through epidemiological studies of large patient populations.
Understanding why disparities exist is complex, and explanations usually include many factors. Some factors can be based on patient beliefs or their biology, or on differences in demographic characteristics. Other factors may be provider-related, such as implicit or explicit bias, and communication with different groups of patients. Still other factors can include policies and practices of the medical center or the health care system itself. Finally, a host of social and environmental factors outside of the health care system may come into play.
Once disparities are identified, and researchers have some understanding of what may be driving them, interventions are designed and tested to reduce or eliminate the problem.
A good example of how the three-phase approach has worked is research by Dr. Said Ibrahim of the Philadelphia VA Medical Center. He has focused on racial disparities in the use of knee and hip replacement surgery in managing advanced osteoarthritis. In early work, his group found that minority patients, and particularly African American Veterans, were significantly less likely than non-minority Veterans to undergo the procedures when they needed them. In looking at why this disparity existed, they found that one leading cause was the level of misinformation about the risk and benefits of the treatment that existed in the minority community. The group eventually went on to conduct a randomized, controlled trial to test an educational intervention for African American patients. They found it significantly increased their willingness to consider knee replacement.
In 2011, the Veterans Health Administration (VHA) chartered a health care equality workgroup. The purpose of the workgroup was to determine how VA could achieve a more equitable health care delivery system.
The workgroup's recommendations supported a dedicated national-level office to champion equitable health care for all Veterans. As a result, the Office of Health Equity (OHE) was established in 2012 to support VHA's vision to provide appropriate individualized health care to every Veteran in a way that eliminates disparate health outcomes and assures health equity.
In October 2016, OHE released the first-ever National Veterans Health Equity report, which details patterns and provides comparative rates of health conditions for Veterans by race and ethnicity, gender, age, geography, and mental health status during fiscal year 2013. Among the report's findings were that all racial and ethnic minority groups had greater use of mental health/substance use disorder services compared with white Veteran patients.
Another finding was that despite their younger average age, female Veterans have higher or similar rates of most diagnosed conditions than male Veterans. Mental health and substance use disorder conditions are far more common in women than in men (46 percent vs. 23 percent.)
Overall, the report found that the distribution of diagnosed conditions between rural and urban Veterans are largely similar, with rural Veterans having higher diagnosed rates of conditions including diabetes and COPD, while urban Veterans have higher diagnosed rates of conditions including HIV and hepatitis C.
Many research studies have shown that in the United States, blacks have worse health outcomes than whites in most categories. Among the possible contributing factors usually cited for the worse outcomes are blacks' lower socioeconomic status and reduced access to care.
Equal access to care—A 2015 study of VA care led by investigators from the Memphis VA Medical Center suggested that when patients have equal access to care, not only do these health differences disappear, but blacks fare better than whites in several important health outcomes. Researchers view VA's equal-access health system as an ideal setting in which to study such issues, since it eliminates or minimizes many of the barriers to care commonly faced by minorities in the private sector.
The team looked at the mortality rates of more than 2.5 million white Veterans and more than 547,000 blacks through VA's electronic health record system. They found that the annual mortality of white males was about 32 per 1,000, versus about 23 per 1,000 for black men. Most of the patients were men with an average age of 60 years.
Blacks in the study were 38 percent less likely than whites to develop heart disease, the leading cause of death in the U.S. The authors suggest that blacks may have certain genetic characteristics that actually make them healthier than whites in some ways.
No racial disparities in VA kidney transplant evaluations—In contrast to what has been found in some private sector studies, VA patients who need a kidney transplant are unlikely to face racial disparities in the evaluation process, according to a 2016 study by researchers based at VA and university sites in Pittsburgh; Nashville; Portland, Oregon; and Iowa City.
The study included 602 patients who were evaluated at one of four VA transplant centers. The researchers found that race did not impact the time Veterans spent in being evaluated for a transplant, from their initial appointment at a transplant center to being accepted and placed on a waitlist. The median "time to acceptance" was 133 days for African Americans, 116 days for whites, and 99 days for other minorities. The differences were not considered statistically significant. These results suggest that specific characteristics of the VA health care system or its patient population may help reduce disparities. The work has influenced a project funded by the National Institutes of Health to test VA's centralized approach to kidney transplant evaluation in a non-VA setting.
Differences in assessment of care among Veterans with MH/SUDs—In a study of a large sample of Veterans with mental health and substance abuse disorders, a team of CHERP investigators found racial and ethnic differences in the way these Veterans assessed their access to care, their communication with providers, the courtesy they received, and the comprehensiveness of the care they received.
The study of nearly 66,000 Veterans found that African American and Hispanic Veterans reported more negative and fewer positive experiences in accessing care than whites; that black Veterans reported fewer communications issues than whites; that Hispanic Veterans reported fewer positive experiences with helpfulness and courtesy than whites; and that Hispanic Veterans reported more negative comprehensiveness experiences than whites, while blacks reported more positive experiences.
Racial disparities in pain management—Researchers at the Minneapolis VA medical center and elsewhere have published several studies in the past few years on the differences in pain screening and management between African Americans and whites. Among their findings were that VA's mandate for pain screening has resulted in high and relatively equitable rates of pain assessment among both African American and white Veterans. Rates of screening for pain are lower among black patients, but the magnitude of this disparity is small and is explained, in part, by variations in the prior use of health care between the two groups.
Another finding by the group is that for patients with chronic pain not related to cancer, blacks under 65 with moderate or high levels of pain were less likely to receive opioids than whites, and that there were no significant differences between the two groups for those with low levels of pain or no pain.
Disparities in health care trust and satisfaction—Another 2015 study, conducted by CHERP researchers, tried to gain insight into why a recent VA hospital report card revealed lower levels of satisfaction with health care for blacks compared to whites.
The team conducted telephone interviews with 30 black and 31 white Veterans who had recently visited one of three VA medical centers. They found that blacks reported less trust and confidence in their VA providers and the VA health care system, and were less satisfied with their communication with their VA health care providers.
Blacks also reported less satisfaction with their outpatient care, but not with their inpatient care. The researchers conducted a larger national study involving 25 VA sites with 750 black, Hispanic, and white Veterans, to gain further insight into the issue and to guide new interventions to reduce this disparity. Results of this study will be reported in the near future.
Prostate cancer—Several VA research teams have recently looked at issues related to black Veterans and prostate cancer. A number of research studies have determined that blacks are at higher risk for prostate cancer than whites. They tend to be about three years younger, on average, when they are diagnosed; their tumors appear to be faster growing; and they are up to three times as likely to die from the cancer.
In 2013, researchers at the VA Connecticut Healthcare System reported that mortality among black and white patients with prostate cancer is similar in health care systems in which black and white patients have equal access, like those managed by VA and the Department of Defense (DoD).
The team based its conclusions on five previous published studies of the VA and DoD health care systems and the National Health Service in Great Britain. They also collected original data on 1,270 Veterans who received care at nine VA health care facilities throughout the United States.
A 2015 study by researchers with VA and the University of California, Los Angeles, looked at more than 1,200 California Veterans with prostate cancer. The team found no significant difference in tumor burden, treatment choice, or survival outcomes between whites and blacks who were cared for by VA.
Another 2015 study, conducted by researchers with VA's New York Harbor Healthcare System and the State University of New York Downstate Medical Center, looked at data on nearly 1,800 men. They found there was little difference in the aggressiveness of prostate tumor growth in black men and white men, and little to suggest that prostate cancer takes a more aggressive course in black men.
Racial/ethnic differences in cardiovascular risk factors among women Veterans—Heart disease is the leading cause of death for women in the United States, accounting for almost a quarter of all deaths among women. Researchers from the VA Greater Los Angeles Healthcare System surveyed more than 3,800 women Veterans nationwide, and found that the risk of developing cardiovascular disease (CVD) varies by race and ethnicity.
Black women Veterans consistently face a higher CVD risk compared to white women Veterans, while the results are mixed for Hispanic women Veterans, who were more likely than white women Veterans to report that daily smoking and diabetes, but less likely to report a diagnosis of hypertension or to be obese.
Internet access disparities—Telehealth interventions over the Internet have been shown to be effective at helping Veterans quit smoking. But racial and sociodemographic disparities may limit the ability of some groups to take advantage of these treatments. A 2016 study found that Veterans who were black, older, less educated, had longer travel times to the nearest VA facility, and have increased nicotine dependence were less likely to access the Internet on a daily basis. These results highlight the importance of improving accessibility to eHealth interventions for low-income, minority, and socially disadvantaged Veteran populations.
Perceived discrimination related to higher rates of cardiovascular disease—A 2012 study by CHERP researchers and university affiliates found that perceived discrimination was related to risk of severe coronary obstruction among black Veterans, but not among white Veterans. White study participants reported less discrimination, negative affect, and religiosity, but more social support, than black participants. Cardiovascular disease affects blacks disproportionately more than whites in the United States. This study suggests that this disparity may be due to chronic stressors such as perceived discrimination.
Kidney transplants—Researchers from the Ralph H. Johnson VA Medical Center in Charleston and the Medical University of South Carolina asked 27 African American kidney recipients about their perspectives on the challengers, barriers, and educational needs related to kidney transplants from living donors.
According to those surveyed in the study, published in 2015, reasons African Americans seek and receive fewer transplants include concerns for the donor; a general lack of knowledge about the process, including risks, the cost of surgery, and the impact on both the donor and the recipients' future health; and the difficulty of approaching potential donors.
Participants thought that an educational program led by an African American recipient of a kidney from a living donor, including teaching potential recipients how to ask others if they might be willing to donate kidneys to them, would increase the number of transplant-eligible patients looking for kidney transplants from living donors.
Non-medical interventions to reduce pain among African Americans—Two ongoing studies are looking at the effects of non-medical ways to reduce pain in Veterans, and the differences in how those interventions affect African Americans and whites. One, conducted by researchers at the VA Pittsburgh Healthcare System, is looking at whether a positive mindset can improve pain outcomes and reduce disparities in patients with osteoarthritis among both groups of Veterans.
Another, by Minneapolis VA researchers, is looking at the effectiveness of an intervention that acknowledges the role of psychological and environmental contributors to pain in Veterans with chronic musculoskeletal pain—some of which are known to differ by race.
Pay-for-performance intervention improves blood pressure control—Hypertension is more prevalent, more severe, and more resistant to treatment in blacks than in whites, and the mortality rate from hypertension is higher in blacks than whites.
In 2016, a team of researchers from the Michael E. DeBakey VA Medical Center in Houston looked at three types of financial incentives for controlling hypertension in black patients. They found that when physicians received an incentive for controlling their patients' blood pressure, control improved as did appropriate responses to uncontrolled blood pressure.
Personal stories more engaging for hypertension management interventions—African-American Veterans felt more engaged when viewing interventions about hypertension management that included personal stories from other Veterans compared with information-only interventions. The study included 618 African-American Veterans with uncontrolled hypertension from three VA medical centers. One group was shown a DVD of information about hypertension, while another was shown a DVD featuring other African-American Veterans telling stories about successfully managing their hypertension. The Veterans who watched real patients tell their stories were more emotionally engaged and reported intentions to change their behavior than the other group, showing that personal stories may be an effective tool to teach patients how to manage their condition.
Telephone-delivered hypertension management—African Americans are significantly more likely than whites to have uncontrolled hypertension. A 2012 CHERP study found that combination intervention (home blood pressure monitoring, remote medication management, and telephone tailored behavioral self-management) appears particularly effective for improving blood pressure among African Americans. This suggests that behavioral factors related to uncontrolled hypertension may impact African American and white Veterans differently.
Peer mentorship for diabetes control—In 2012, researchers at the Philadelphia VA Medical Center paired African American Veterans with persistently poor diabetes control with peer mentors who formerly had poor diabetes control but now have good control. The study showed that patients paired with a mentor reduced their glycemic levels more than patients in a control group or patients who were offered a financial incentive. These results show that peer mentorship may be a powerful tool to improve clinical outcomes and reduce disparities in African American Veterans with diabetes.
There are an estimated 700,000 people in the United States who identify as transgender (they identify with or express a gender identity that differs from the one that corresponds to their sex at birth).
Treatments available to transgender Veterans—Between 2006 and 2013, VA served some 2,600 transgender Veterans, and the numbers are rising, according to a 2014 study by VA researchers. VA's policy is that transgender Veterans deserve respect and dignity. While VA does not perform sex reassignment surgery, nor does the department pay for it, treatments available for transgender Veterans at VA include hormonal therapy, mental health care, preoperative evaluations, and care following surgery.
Racial health disparities in transgender Veterans—In 2014, two VA researchers identified 5,135 transgender Veterans receiving care from VHA. Of that number, 387 were black. They reviewed their health care records and found that black transgender Veterans were generally more socially disadvantaged than whites, and that several mental and physical conditions occurred more frequently in blacks, including alcohol abuse, congestive heart failure, and HIV/AIDS.
Medical and mental health disparities for transgender Veterans—A 2015 study led by researchers at the Mountain Home VA Medical Center and VA's Office of Health Equity found that medical and mental health disparities exist in VA for clinically diagnosed transgender Veterans, compared with a matched group of Veterans without that diagnosis.
The researchers found that transgender Veterans were significantly more likely to suffer from all 10 of the mental health conditions the study examined, including depression, suicidal thoughts or intentions, serious mental illness, and PTSD. They also had a much higher prevalence of 16 of 17 medical diagnoses studied, with HIV infection accounting for the largest disparity.
According to the investigators, these findings will have significant implications for policy, health care screening, and service delivery in VA, and possibly for other health care systems as well.
Home-based primary care improves access to long-term care for American Indian Veterans—Home based primary care (HBPC) is a model of noninstitutional long-term care used by VA to provide ongoing care to homebound persons. The program allows individual VA medical centers to tailor their model to fit the population and region.
For rural American Indian Veterans, HBPC is a way to receive long-term care once clinic-based care is no longer realistic.
In 2015, a team led by researchers from the VA Greater Los Angeles Healthcare System interviewed VA leaders and staff from 14 VA medical centers on their HBPC programs for American Indians.
They found that 12 had programs specifically aimed at American Indians in reservation communities, and they observed six different successful models of home-based care, all of which were driven by patient-centered care that allowed Veterans to determine their provider of choice based on convenience, cost, and availability of service. They also found "a real learning curve" for facilities to learn to work with tribal governments, and that trust was the key to establishing working relationships and creating successful HBPC programs.
The concentration of hospital care for black veterans in Veterans Affairs hospitals: implications for clinical outcomes. Jha AK, Stone R, Lave J, Chen H, Klusaritz H, Volpp K. An assessment of differences in mortality rates between black and white veterans across 150 VA hospitals for any of six conditions (acute myocardial infarction, hip fracture, stroke, congestive heart failure, gastrointestinal hemorrhage, and pneumonia) between 1996 and 2002. J Healthc Qual. 2010 Nov-Dec;32(6):52-61.
A national study of racial differences in pain screening rates in the VA health care system. Burgess DJ, Gravely AA, Nelson DB, van Ryn M, Bair MJ, Kearns RD, Higgins DM, Partin MR. Rates of pain screening at VA facilities were lower among black patients. The magnitude of this disparity was small and was explained, in part, by racial variation in prior health care utilization. Clin J Pain. 2013 Feb;29(2):118-23.
Primary care provider cultural competence and racial disparities in HIV care and outcomes. Saha S, Korthuis PT, Cohn JA, Sharp VL, Moore RD, Beach MC. Provider cultural competency was associated with the quality and equity of HIV care. J Gen Intern Med. 2013 May; 28(5):622-9.
Racial/ethnic differences in cardiovascular risk factors among women Veterans. Rose DE, Farmer MM, Yano EM, Washington DL. Black women Veterans consistently face higher cardiovascular disease risk compared to white women Veterans, while results are mixed for Hispanic women Veterans. J Gen Intern Med. 2013 Jul; 28 Suppl 2:S524-8.
'Race' and prostate cancer mortality in equal-access healthcare systems, Graham-Steed T, Uchio E, Wells CK, Aslan M, Ko J, Concato J. Mortality among black and white patients with prostate cancer is similar in equal-access healthcare systems. Studies that find racial differences in mortality among men with prostate cancer may not account fully for socioeconomic and clinical factors. Am J Med. 2013 Dec;126(12):1084-8.
Alabama Veterans rural health initiative: a pilot study of enhanced community outreach in rural areas. Hilgemann MM, Mahaney-Rice AF, Stanton MP, McNeal SF, Pettey KM, Tabb KD, Litaker MS, Parmelee P, Hamner K, Martin MY, Hawn MT, Kertesz SG, Davis LL: Alabama Veterans Rural Health Initiative steering committee. There is need for a specific outreach intervention that speeds enrollment and engagement for rural individuals in VA services. J Rural Health. 2014 Spring;30(2):153-63.
Rural women Veterans demographic report: defining VA users' health and health care access in rural areas. Brooks E, Dailey N, Bair B, Shore J. Improved service options for women's specific care and mental health visits may help rural women Veterans access care. Telehealth technologies and increased outreach, perhaps peer-based, should be considered. J Rural Health. 2014 Spring;30(2):146-52.
Access to care for transgender Veterans in the Veterans Health Administration: 2006-2013. Kauth MR, Shipherd JC, Lindsay J, Blosnich JR, Brown GR, Jones KT. A bottom-up push for services by Veterans and top-down education likely worked synergistically to sped implementation of a VA mandate to provide medically necessary care for transgender Veterans and improve their access to VA care. Am J Public Health. 2014 Sep;104 Suppl 4:S532-4.
Racial health disparities in a cohort of 5,135 transgender Veterans. Brown GR, Jones KT. Black transgender Veterans have a greater likely hood of social disadvantage and prevalence of several mental and medical conditions compared to white transgender Veterans. J Racial and Ethnic Health Disparities. 2014 1:257.
Improving access to noninstitutional long-term care for American Indian Veterans. Kramer BJ, Creekmur B, Cote S, Saliba D. VA's home-based primary care program is flexible, and offers opportunities for expansion of health care access for American Indians and non-Indians, particularly in rural areas. J Am Geriatr Soc. 2015 Apr;63(4):789-96.
Explaining racial disparities in anticoagulation control: results from a study of patients at the Veterans Administration. After accounting for the younger age of blacks, greater degrees of medication use, hospitalization, poverty, living in the South, and 11 other patient characteristics, differences in anticoagulation control between blacks and whites almost disappeared. Am J Med Qual. 2015 May;30(3):214-22.
Racial parity in tumor burden, treatment choice and survival outcomes in men with prostate cancer in the VA healthcare system. Daskivich TJ, Kwan L, Dash A, Litwin MS. There were no significant differences in tumor burden, treatment choice, or survival outcomes between blacks and whites cared for in the equal-access VA health care system. Prostate Cancer Prostatic Dis. 2015 Jun;18(2):104-9.
Racial differences in chronic conditions and sociodemographic characteristics among high-utilizing Veterans. Breland JY, Chee CO, Zulman DM. Racial disparities among Veterans who use the VA health care system frequently may differ from those found in the general population. J Racial Ethn Health Disparities. 2015 Jun;2(2):167-75.
Warfarin pharmacogenomics and African ancestry. Price ET. Racially informed warfarin pharmacogenetic algorithms perform better than traditional algorithms, which previously excluded genetic variants unique to patients with African ancestry. Blood. 2015 Jul 23;126(4):434-6.
A population-based study of men with low-volume low-risk prostate cancer: does African-American race predict for more aggressive disease? Schreiber D, Chhabra A, Rineer J, Wedon J, Schwartz D. In the absence of definitive data to support a more aggressive natural history of very low risk prostate cancer in African-American men, data from this study supports continued use of active surveillance in this population. Clin Genitorurin Cancer. 2015 Aug;13(4):e259-64.
Racial differences in satisfaction with VA health care: a mixed methods pilot study. Zickmund SL, Burkitt KH, Gao S, Stone RA, Rodriguez KL, Switzer GE, Shea JA, Bayliss NK, Meiksin R, Walsh MB, Fine MJ. A study demonstrating racial differences in satisfaction with outpatient care and identifying some specific sources of dissatisfaction. J Racial Ethn Health Disparities. 2015 Sep:2(3):317-29.
Association of race with mortality and cardiovascular events in a large cohort of US Veterans, Kovesdy CP, Norris KC, Boulware LE, Lu JL, Ma JZ, Streja E, Molnar MZ, Kalantar-Zadeh K. Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all-cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population. Circulation. 2015 Oct 20;132(16):1538-48.
Mental health and medical health disparities in 5135 transgender Veterans receiving healthcare in the Veterans Health Administration: a case-control study. Brown GR, Jones KT. Transgender Veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-transgender Veterans. LGBT Health, 2015 Dec 16. (Epub ahead of print)
Racial/Ethnic differences in primary care experiences in patient-centered medical homes among Veterans with mental health and substance use disorders. Jones AL, Mor MK, Cashy JP, Gordon AJ, Hass GL, Schaefer JH Jr, Hausmann LR. In a national sample of Veterans with mental health and substance use disorders, potential deficiencies were observed in access, self-management support, and comprehensiveness. J Gen Intern Med. 2016 Jun 20. (Epub ahead of print)
Impact of a pay-for-performance program on care for black patients with hypertension: important answers in the era of the Affordable Care Act. Petersen LA, Ramos KS, Pietz K, Woodard LD. A pay for performance intervention improved blood pressure control or appropriate response to uncontrolled blood pressure in black patients and did not produce risk selection. Health Serv Res. 2016 Jun 22. (Epub ahead of print)
Has the Department of Veterans Affairs found a way to avoid racial disparities in the evaluation process for kidney transplantation? Freeman MA, Pleis JR, Bornemann K, Croswell E, Dew MA Chang CH, Switzer GE, Langone A, Mittal-Henkle A, Saha S, Ramkumar M, Flohr JA, Thomas CP, Myaskovsky L. The VA National Transplant System did not exhibit the racial disparities in evaluation for kidney transplants that have been found in non-VA transplant centers. Transplantation. 2016 Aug 1. (Epub ahead of print.)
Association between pain outcomes and race and opioid treatment: retrospective cohort study of Veterans. Burgess DJ, Gravely AA, Nelson DB, Bair MJ, Kerns RD, Higgins DM, Farmer MM, Partin MR. Receipt of an opioid prescription was associated with greater pain interference and was not associated with perceived treatment effectiveness for most patients. JRRD, Vol. 53 Number 1, 2016, pp. 13-24.
Older, white males with advanced bladder cancer at high risk for suicide, GReport, March 4, 2015
Military women are at the same risk of PTSD as men, study finds, The Washington Post, Aug. 21, 2015
Surprising discovery on racial disparities in health care, CBS News, Sept. 25, 2015
Transgender Veterans diagnosed with significantly more mental and medical health disorders, Genetic Engineering News, Jan. 6, 2016
Blumenthal, others back bill that aims to stem suicides of women Veterans, New Haven Register, Feb. 9, 2016
Office of Health Equity, U.S. Department of Veterans Affairs
Center for Minority Veterans, U.S. Department of Veterans Affairs
Center for Women Veterans, U.S. Department of Veterans Affairs
Center for Disease Prevention and Health Interventions for Diverse Populations, U.S. Department of Veterans Affairs
VA Center Working to Improve Health Equity, VAntage Point blog, U.S. Department of Veterans Affairs
Office of Minority Health , U.S. Department of Health and Human Services
Health Disparities, Health Services Research Information Center, U.S. National Library of Medicine, National Institutes of Health
Health Disparities, National Library of Medicine, MedlinePlus