Racial/Ethnic Disparities in Mortality Across the Veterans Health Administration
Abstract: Equal-access health care systems such as the Veterans Health Administration (VHA) reduce financial and nonfinancial barriers to care. It is unknown if such systems mitigate racial/ethnic mortality disparities, such as those well documented in the broader U.S. population. We examined racial/ethnic mortality disparities among VHA health care users, and compared racial/ethnic disparities in VHA and U.S. general populations. Linking VHA records for an October 2008 to September 2009 national VHA user cohort, and National Death Index records, we assessed all-cause, cancer, and cardiovascular-related mortality through December 2011. We calculated age-, sex-, and comorbidity-adjusted mortality hazard ratios. We computed sex-stratified, age-standardized mortality risk ratios for VHA and U.S. populations, then compared racial/ethnic disparities between the populations. Among VHA users, American Indian/Alaskan Natives (AI/ANs) had higher adjusted all-cause mortality, whereas non-Hispanic Blacks had higher cause-specific mortality versus non-Hispanic Whites. Asians, Hispanics, and Native Hawaiian/Other Pacific Islanders had similar, or lower all-cause and cause-specific mortality versus non-Hispanic Whites. Mortality disparities were evident in non-Hispanic-Black men compared with non-Hispanic White men in both VHA and U.S. populations for all-cause, cardiovascular, and cancer (cause-specific) mortality, but disparities were smaller in VHA. VHA non-Hispanic Black women did not experience the all-cause and cause-specific mortality disparity present for U.S. non-Hispanic Black women. Disparities in all-cause and cancer mortality existed in VHA but not in U.S. population AI/AN men. Patterns in racial/ethnic disparities differed between VHA and U.S. populations, with fewer disparities within VHAs equal-access system. Equal-access health care may partially address racial/ethnic mortality disparities, but other nonhealth care factors should also be explored.
Abstract: U.S. Air Force remotely piloted aircraft (USAF RPA) personnel face diverse stressors negatively affecting psychological health and military readiness. Prior research in diverse populations supports predictable impact of the COVID-19 pandemic on occupational stressors, burnout, and more distal outcomes. Extending earlier studies linking broad variables (e.g., COVID-19 threat → work stress → burnout), the current study tests and refines an expanded mediation model based on multiple distinct pandemic concerns, occupational stressors, and burnout facets as antecedents of psychological distress mid-pandemic in RPA personnel (N = 496). Differential representation of demands, resources, and rewards evident across distinct occupational stressors in light of job demands/resources theory guided specification of mediated pathways. SEM analysis yielded moderate fit. Following removal of non-significant paths and addition of two interpretable direct paths, fit was improved, yielding seven dominant pandemic concern → occupational stressor → burnout → psychological distress pathways. In support of domain specification, five 'hub' variables (pandemic-driven change, personal stressors, workload, leader communication, and exhaustion) emerged as key intervention targets in mitigating distress in the USAF RPA community and similar populations during future pandemic-related crises.