December 2007 AJPH Highlights: Health Care for Veterans

Newswise — The articles below will be published online Oct. 30, 2007, at 4 p.m. (EDT) by the American Journal of Public Health under "First Look" at http://www.ajph.org/first_look.shtml, and will appear in the December 2007 print issue of the Journal. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, http://www.apha.org, and is available at http://www.ajph.org.

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(1) NEARLY 1.8 MILLION U.S. VETERANS WITHOUT HEALTH CARE COVERAGEIn 2004, almost 1.8 million U.S. veterans and 3.8 million members of veterans' households were without health care coverage. Uninsured veterans and veterans' households accounted for 12.2 percent of uninsured Americans.

Researchers analyzed data from two national surveys, including the annual March Supplement to the Current Population Survey, to determine the number of uninsured veterans, trends in coverage and access to medical care. Among all veterans, 7.7 percent were uninsured, including 12.7 percent of those aged 64 or younger. The lack of health insurance among veterans seems to be worsening, with an increase of 300,000 uninsured veterans between 2000 and 2004.

"Like other uninsured adults, most uninsured veterans are low- to middle-income workers, who may be too poor to afford private coverage but are not poor enough to qualify for Medicaid or free VA [Veteran's Health Administration] care," the study's authors said. "We owe veterans care not because they can pay for it nor because they are heroes but — as their sacrifices remind us — because members of a society are obligated to serve and protect each other." [From: "Lack of Health Coverage Among U.S. Veterans from 1987 to 2004." ]

(2) YOUNGER WHITE MALE VETERANS AT INCREASED RISK OF SUICIDEMale veterans are three times more likely than female veterans to commit suicide. Also, whites have a much higher rate of suicide compared with patients of other races.

Researchers examined associations between demographic and clinical characteristics and risk of suicide among veterans treated for depression in the Veteran's Health Administration (VA) system. Out of 807,694 veterans included in the study, 1,683 — or 0.21 percent — committed suicide during the study period. Data suggests that the rate of suicide among male veterans is three times higher than the rate among female veterans, less than the 4:1 ratio reported for the general population. In addition, the rate of suicide among whites was 95.01 per 100,000 person-years, much higher than the 27.08 per 100,000 person-years for blacks and 56.17 per 100,000 person-years for other races. Younger veterans aged 18"44 had moderately higher suicide rates than did middle-aged patients aged 45"65 and modestly higher rates than elderly patients (94.98, 77.93 and 90.06 per 100,000 person-years, respectively). Surprisingly, veterans diagnosed with posttraumatic stress disorder (PTSD) had a lower rate of suicide than those without PTSD.

"These findings can help identify depressed veterans at greatest risk of suicide, allowing providers in the VA health care system to more closely monitor these patients and can provide policy-makers with valuable information about high-risk veterans," the study's authors said. [From: "Suicide Mortality Among Individuals Receiving Treatment for Depression in the Veterans Affairs Health System: Associations with Patient and Treatment Setting Characteristics." ]

(3) ELEVEN PERCENT OF MEN IN THE UNITED STATES HAVE HAD CONCURRENT SEXUAL PARTNERS IN THE PAST YEARConcurrent partnerships, or partnerships that overlap in time, can contribute to the heterosexual transmission of HIV and other sexually transmitted infections.

The study examined the prevalence of concurrent partnerships among men by analyzing data from the 2002 National Survey of Family Growth. Out of 4,928 participants, 11 percent had concurrent sexual partnerships within the previous 12 months. Prevalence of concurrency varied substantially by ethnicity, with black men and Hispanic men twice as likely as white men to have had concurrent partnerships. Men with concurrency were less likely than were men without concurrency to have used a condom during last sexual intercourse. Concurrency was also associated with being unmarried, having been incarcerated during the previous year and earlier age of first sexual intercourse.

"The higher prevalence [of concurrency] in various groups and indications of dense sexual networks, mixing between high-risk subpopulations, and mixing between high-risk subpopulations and the general population may be important factors in the epidemiology of heterosexual HIV infection," the study's authors said. [From: "Concurrent Sexual Partnerships Among Men in the United States," ]

(4) PARENTS LESS LIKELY THAN NON-PARENTING ADULTS TO SUFFER SERIOUS PSYCHOLOGICAL DISTRESSParents often complain that their children are "driving them crazy," but new research suggests just the opposite may be true.

According to researchers at RTI International, the incidence of reported serious psychological distress is significantly lower among adult parents than among non-parenting adults of the same age in the United States.

Researchers compared the prevalence of serious psychological distress among parenting and non-parenting adults, as reported in data from over 33,000 adults who participated in the 2002 National Survey on Drug Use and Health. According to their analysis, the incidence of serious psychological distress within the past year was 12 percent among non-parenting adults aged 18-49, compared with 8.9 percent for parents.

"Although the news is generally good for parents, we should also recognize that parents in specific situations, particularly those with low incomes, face very stressful situations that can lead to serious psychological distress," said Mindy Herman-Stahl, Ph.D., a senior researcher at RTI International and the study's lead author.

Among all adults, the risk of serious psychological distress was highest among those who are younger, have lower household incomes, are divorced or separated, and those receiving Medicaid.

"Increased screening and access to coordinated and culturally appropriate mental health treatment that address parenting issues for high-risk groups of parenting adults are crucial for reducing the public health burden of parent mental health problems," the study's authors said. [From: "Serious Psychological Distress Among Parenting and Non-parenting Adults." ]

(5) BLACKS 35 PERCENT MORE LIKELY TO LEAVE HOSPITALS AGAINST MEDICAL ADVICEApproximately one in 70 hospital discharges are against medical advice.

Researchers utilized the Nationwide Inpatient Sample of the Health Care Cost and Utilization Project to examine hospital- and patient-related factors associated with discharge against medical advice. Patients discharged against medical advice were generally younger in age, male and of low socioeconomic status. When compared with white patients, blacks had a 35 percent higher risk of discharge against medical advice, whereas Hispanics had a 10 percent lower risk. The primary diagnostic category associated with self-discharge was mental health disorder.

"Understanding the characteristics of patients who leave the hospital against medical advice and gaining insight into their reasons are important because resource allocation, delivery of medical care, and quality of care are affected," the study's authors said. "Higher rates of discharges against medical advice in general or in special populations (e.g., racial/ethnic minorities) may signify shortcomings of the system that need to be addressed to improve quality of care for all patients." [From: "Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice." ]

The American Journal of Public Health is the monthly journal of the American Public Health Association (APHA), the oldest organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at www.apha.org.