Characteristics Associated with Persistent Versus Transient Food Insecurity Among US Veterans Screened in the Veterans Health Administration
Abstract: Awareness of negative health impacts associated with food insecurity among US veterans is growing. Yet, little research has examined characteristics associated with persistent vs transient food insecurity. Our aim was to investigate characteristics associated with persistent vs transient food insecurity among US veterans. The study used a retrospective, observational design to examine data from Veterans Health Administration electronic medical records. The sample consisted of veterans (n = 64,789) who screened positive for food insecurity in Veterans Health Administration primary care during fiscal years 2018-2020 and were rescreened within 3 to 5 months. Food insecurity was operationalized using the Veterans Health Administration food insecurity screening question. Transient food insecurity was a positive screen followed by a consecutive negative screen within 3 to 15 months. Persistent food insecurity was a positive screen followed by a consecutive positive screen within 3 to 15 months. A multivariable logistic regression model was used to assess characteristics (eg, demographic characteristics, disability rating, homelessness, and physical and mental health conditions) associated with persistent vs transient food insecurity. Veterans with increased odds of persistent vs transient food insecurity included men (adjusted odds ratio [AOR] 1.08; 95% CI 1.01 to 1.15) and those from Hispanic (AOR 1.27; 95% CI 1.18 to 1.37) or Native American (AOR 1.30; 95% CI 1.11 to 1.53) racial and ethnic groups. Psychosis (AOR 1.16; 95% CI 1.06 to 1.26); substance use disorder, excluding tobacco and alcohol (AOR 1.11; 95% CI 1.03 to 1.20); and homelessness (AOR 1.32; 95% CI 1.26 to 1.39) were associated with increased odds of persistent vs transient food insecurity. Veterans who were married (AOR 0.87; 95% CI 0.83 to 0.92) or had a service-connected disability rating of 70% to 99% (AOR 0.85; 95% CI 0.79 to 0.90) or 100% (AOR 0.77; 95% CI 0.71 to 0.83) had lower odds of persistent vs transient food insecurity. Veterans at risk for persistent vs transient food insecurity may struggle with underlying issues like psychosis, substance use, and homelessness in addition to racial and ethnic inequities and gender differences. More research is needed to understand the characteristics and mechanisms that increase risk for persistent vs transient food insecurity among veterans.
Abstract: The Department of Veterans Affairs (VA) is the largest integrated health care system in the US. However, most enrollees (80%) have other health insurance. Veterans’ selective use of VA health care creates an immense challenge for VA leadership, the scale of which is relatively unknown. The VA allocates substantial resources to improve equitable access, prevent suicides, and provide transparency on hospital quality by analyzing VA-provided and VA-purchased care. These analyses will be inaccurate if patient health and reliance on the VA are linked, especially as the VA expands its role as a payer of care and the recently passed PACT Act brings in younger veterans, who are more likely to have private health insurance. This study investigated whether VA reliance was associated with self-reported health, a predictor of health outcomes, and whether this association varied for individuals with different types of outside insurance using a nationally representative survey.