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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 10/2018

01-10-2018 | Review Paper

Evidence Review—Social Determinants of Health for Veterans

Authors: Wei Duan-Porter, MD, PhD, Brian C. Martinson, PhD, Nancy Greer, PhD, Brent C. Taylor, PhD, Kristen Ullman, MPH, Lauren McKenzie, MPH, Christina Rosebush, MPH, Roderick MacDonald, MS, Samuel Falde, BS, Timothy J. Wilt, MD, MPH

Published in: Journal of General Internal Medicine | Issue 10/2018

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Abstract

Background

Veterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans.

Method

MEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation.

Results

We screened 7242 citations and found 131 eligible articles—99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence).

Discussion

Little published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
Appendix
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Metadata
Title
Evidence Review—Social Determinants of Health for Veterans
Authors
Wei Duan-Porter, MD, PhD
Brian C. Martinson, PhD
Nancy Greer, PhD
Brent C. Taylor, PhD
Kristen Ullman, MPH
Lauren McKenzie, MPH
Christina Rosebush, MPH
Roderick MacDonald, MS
Samuel Falde, BS
Timothy J. Wilt, MD, MPH
Publication date
01-10-2018
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 10/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-018-4566-8

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