Today's Veteran population is racially and ethnically diverse, and includes more women and individuals from vulnerable populations, such as those identifying as lesbian, gay, bisexual, and transgender (LGBT), than at any other time in history. While the equal access nature of the Veterans Health Administration (VHA) may succeed in mitigating some of the disparities related to socioeconomic status (SES), it does not directly address the potential for disparities related sociodemographic factors (eg, race/ethnicity, gender, LGBT identity, age), geographic location, and mental health status. An understanding of whether disparities in utilization, health, or healthcare exists for Veterans belonging to vulnerable populations is vital. Both the Veterans Administration (VA) and the VHA have emphasized the mitigation and elimination of health disparities in their strategic plans, and have outlined specific goals in the VHA Health Equity Plan and the Blueprint for Excellence.Over the last decade, the VA Evidence-based Synthesis Program (ESP) and other organizations have published systematic reviews examining the quality of the health and healthcare experienced by a variety of vulnerable Veteran populations.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
  • ABBREVIATIONS
• INTRODUCTION
  • RACE AND ETHNICITY
  • WOMEN'S HEALTH
  • MENTAL HEALTH
  • RURAL RESIDENCE AND DISTANCE
  • LESBIAN, GAY, BISEXUAL, AND TRANSGENDER (LGBT)
  • THE CURRENT REVIEW
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SUMMARY
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1. For what Veteran groups/populations are health and healthcare disparities prevalent?
  • KEY QUESTION 2. What are the effects of interventions implemented within the VHA to reduce health disparities?
  • KEY QUESTION 3. What are the research projects designed to identify or mitigate health disparities currently being funded by the VA Office of Research and Development (ORD)?
• DISCUSSION AND CONCLUSION
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. TECHNICAL EXPERT PANEL AND PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX C. STUDY SELECTION
• APPENDIX D. KEY QUESTION 1 STUDY DISTRIBUTION BY CLINICAL AREA AND CATEGORY
• APPENDIX E. HEALTH DISPARITIES BY RACE/ETHNICITY – AFRICAN AMERICAN/BLACK
• APPENDIX F. HEALTH DISPARITIES BY RACE/ETHNICITY – HISPANIC/LATINO
• APPENDIX G. HEALTH DISPARITIES BY RACE/ETHNICITY – AMERICAN INDIAN/ALASKA NATIVE
• APPENDIX H. HEALTH DISPARITIES BY RACE/ETHNICITY – ASIAN/PACIFIC ISLANDER
• APPENDIX I. HEALTH DISPARITIES BY RACE/ETHNICITY – NATIVE HAWAIIAN/PACIFIC ISLANDER
• APPENDIX J. HEALTH DISPARITIES AMONG WOMEN
• APPENDIX K. HEALTH DISPARITIES IN VETERANS WITH A MENTAL HEALTH CONDITION
• APPENDIX L. HEALTH DISPARITIES ACCORDING TO AGE
• APPENDIX M. HEALTH DISPARITIES ACCORDING TO RURAL RESIDENCE OR DISTANCE FROM VA MEDICAL CENTER
• APPENDIX N. HEALTH DISPARITIES ACCORDING TO SOCIOECONOMIC STATUS
• APPENDIX O. HEALTH DISPARITIES IN VETERANS WITH DISABILITIES
• APPENDIX P. HEALTH DISPARITIES BY ERA OF MILITARY SERVICE
• APPENDIX Q. HEALTH DISPARITIES AMONG LGBT VETERANS
• APPENDIX R. HEALTH DISPARITIES AMONG HOMELESS VETERANS
• APPENDIX S. INTERVENTIONS DESIGNED TO REDUCE DISPARITIES (KEY QUESTION 2)
• APPENDIX T. STUDIES CLASSIFYING RACIAL/ETHNIC MINORITIES AS NON-WHITE

Suggested citation:

Kondo K, Low A, Everson T, et al Prevalence of and Interventions to Reduce Health Disparities in Vulnerable Veteran Populations: A Map of the Evidence. VA ESP Project #05-225; 2017.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the VA Portland Health Care System, Portland, OR, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.