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Day G, Ecker AH, Amspoker AB, Dawson DB, Walder A, Hogan JB, Lindsay JA. Black veteran use of video telehealth for mental health care. Psychol Serv 2024; 21:478-488. [PMID: 38059987 PMCID: PMC11156787 DOI: 10.1037/ser0000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Black veterans experience disparities in mental health (MH) care access and are disproportionately affected by COVID-19. Video telehealth to home (VTH) may reduce disparities by addressing barriers, particularly with pandemic-related shifts to remotely delivered care. Considering potential needs for tailored implementation across racial/ethnic groups, we examined differences in VTH use by non-Hispanic Black veterans versus all other races/ethnicities and among Black (Hispanic and non-Hispanic) veterans by age, rurality, and gender during the pandemic. We extracted a cohort of Veterans Health Administration-enrolled veterans receiving at least one MH encounter between October 2019 and September 2020 (n = 1,627,791) from electronic health records. Multilevel linear growth curve models examined the percentage of VTH use for non-Hispanic Black versus other races/ethnicities before and after pandemic onset. Black veteran-only subgroup analyses examined differences by ethnicity in percentage of VTH MH encounters since pandemic onset by age, rurality, and gender, using regression and analysis of covariance models. Despite significant increases in VTH during the pandemic, on average, VTH use was consistently lower for non-Hispanic Black veterans across both periods. During the pandemic, differences in VTH use between non-Hispanic Black and non-Black veterans accelerated over time. VTH use was greater during the pandemic for Black veterans who were Hispanic, younger, urban, and female. Adoption of VTH for MH was low for non-Hispanic Black veterans before COVID-19 and during COVID-19 compared to non-Black groups. Future VTH research and implementation efforts should question why adoption remains low, work to meet cultural needs, and promote equitable adoption for Black veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Giselle Day
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Anthony H. Ecker
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amber B. Amspoker
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Darius B. Dawson
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Annette Walder
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
| | - Julianna B. Hogan
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jan A. Lindsay
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Baker Institute for Public Policy, Rice University, Houston, TX, USA
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Weinberger DM, Rose L, Rentsch C, Asch SM, Columbo JA, King J, Korves C, Lucas BP, Taub C, Young-Xu Y, Vashi A, Davies L, Justice AC. Excess Mortality Among Patients in the Veterans Affairs Health System Compared With the Overall US Population During the First Year of the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2312140. [PMID: 37155169 PMCID: PMC10167568 DOI: 10.1001/jamanetworkopen.2023.12140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/24/2023] [Indexed: 05/10/2023] Open
Abstract
Importance During the first year of the COVID-19 pandemic, there was a substantial increase in the rate of death in the United States. It is unclear whether those who had access to comprehensive medical care through the Department of Veterans Affairs (VA) health care system had different death rates compared with the overall US population. Objective To quantify and compare the increase in death rates during the first year of the COVID-19 pandemic between individuals who received comprehensive medical care through the VA health care system and those in the general US population. Design, Setting, and Participants This cohort study compared 10.9 million enrollees in the VA, including 6.8 million active users of VA health care (those with a visit in the last 2 years), with the general population of the US, with deaths occurring from January 1, 2014, to December 31, 2020. Statistical analysis was conducted from May 17, 2021, to March 15, 2023. Main Outcomes and Measures Changes in rates of death from any cause during the COVID-19 pandemic in 2020 compared with previous years. Changes in all-cause death rates by quarter were stratified by age, sex, race and ethnicity, and region, based on individual-level data. Multilevel regression models were fit in a bayesian setting. Standardized rates were used for comparison between populations. Results There were 10.9 million enrollees in the VA health care system and 6.8 million active users. The demographic characteristics of the VA populations were predominantly male (>85% in the VA health care system vs 49% in the general US population), older (mean [SD], 61.0 [18.2] years in the VA health care system vs 39.0 [23.1] years in the US population), and had a larger proportion of patients who were White (73% in the VA health care system vs 61% in the US population) or Black (17% in the VA health care system vs 13% in the US population). Increases in death rates were apparent across all of the adult age groups (≥25 years) in both the VA populations and the general US population. Across all of 2020, the relative increase in death rates compared with expected values was similar for VA enrollees (risk ratio [RR], 1.20 [95% CI, 1.14-1.29]), VA active users (RR, 1.19 [95% CI, 1.14-1.26]), and the general US population (RR, 1.20 [95% CI, 1.17-1.22]). Because the prepandemic standardized mortality rates were higher in the VA populations prior to the pandemic, the absolute rates of excess mortality were higher in the VA populations. Conclusions and Relevance In this cohort study, a comparison of excess deaths between populations suggests that active users of the VA health system had similar relative increases in mortality compared with the general US population during the first 10 months of the COVID-19 pandemic.
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Affiliation(s)
- Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Liam Rose
- Department of Veterans Affairs Medical Center, Palo Alto, California
- Surgery Policy Improvement Research and Education Center, Stanford School of Medicine, Palo Alto, California
| | - Christopher Rentsch
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Steven M. Asch
- Department of Veterans Affairs Medical Center, Palo Alto, California
- Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, California
- Department of Health Research and Policy, Stanford School of Medicine, Palo Alto, California
| | - Jesse A. Columbo
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joseph King
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
- Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Caroline Korves
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
| | - Brian P. Lucas
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Cynthia Taub
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Yinong Young-Xu
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
| | - Anita Vashi
- Department of Veterans Affairs Medical Center, Palo Alto, California
- Department of Health Research and Policy, Stanford School of Medicine, Palo Alto, California
- Department of Emergency Medicine, University of California, San Francisco
| | - Louise Davies
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Amy C. Justice
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Feyman Y, Avila CJ, Auty S, Mulugeta M, Strombotne K, Legler A, Griffith K. Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic. Health Serv Res 2022; 58:642-653. [PMID: 36478574 PMCID: PMC9878051 DOI: 10.1111/1475-6773.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. DATA SOURCES Administrative data from the Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. DATA COLLECTION We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity. PRINCIPAL FINDINGS Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. CONCLUSIONS Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.
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Affiliation(s)
- Yevgeniy Feyman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Cecille Joan Avila
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Samantha Auty
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha Mulugeta
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kiersten Strombotne
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Aaron Legler
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kevin Griffith
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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