Sex-specific differences in physical health and health services use among Canadian Veterans: a retrospective cohort study using healthcare administrative data

Primary Care Visit Rates Among Canadian Veterans in Ontario: A Retrospective Cohort Study of Sex- and Length of Service-stratified Comparisons With Nonveterans

INTRODUCTION

Research comparing primary care (PC) use among veterans and nonveterans has not widely considered the impact of sex and length of service on the association between veteran status and PC use. We calculated relative differences in the rate of PC visits between Canadian Armed Forces and Royal Canadian Mounted Police veterans and nonveterans overall and by sex and length of service.

MATERIALS AND METHODS

We conducted a matched, retrospective cohort study of Canadian veterans and nonveterans residing in Ontario, Canada between 1990 and 2019 using routinely collected linked administrative health care data held at ICES (formerly known as the Institute for Clinical Evaluative Sciences). We compared PC visit rates using multivariable Andersen-Gill (AG) recurrent event regression models. Effect measure modification by sex and length of service was investigated using statistical interaction terms.

RESULTS

Overall, veterans had a higher adjusted relative rate (aRR) of PC visits compared to nonveterans (aRR 1.06, 95% CI 1.04-1.07). Male veterans had an aRR of 1.07 (95% CI, 1.05-1.09), while females had an aRR of 1.31 (95% CI, 1.26-1.36). Veterans who served for <5 years had a significantly higher rate of PC visits relative to nonveterans (RR 1.09, 95% CI 1.03-1.15), while veterans who served for ≥30 years had comparable rates to nonveterans (RR 1.00, 95% CI 0.97-1.02).

CONCLUSIONS

Veterans had an overall higher rate of PC visits compared to nonveterans, and the effect of veteran status appeared stronger among females and veterans with fewer years of service. The observed differences in rates of PC use could be the result of increased need, increased access to PC, or proactive health care-seeking behaviors retained from military service.

UK female veterans' physical health: perceived impact of military service and experiences of accessing healthcare. Findings of a qualitative study

INTRODUCTION

Women make up almost 14% of the UK's veteran population; however, little is known about female veterans' physical health and experiences of accessing healthcare after military service. As part of a qualitative study to understand female veterans' experiences of statutory and charitable support, participants were asked if they felt anything about their military service had impacted their physical health as civilians. They were also asked about their experiences with accessing healthcare and any associated challenges. The aim of this paper is to outline participants' responses to inform the development of further research.

METHODS

85 women who had served in the British Armed Forces took part in semistructured interviews conducted via Microsoft Teams between June and December 2022. Reflexive thematic analysis of interview transcripts was conducted to identify, analyse and report repeated patterns in responses to questions.

RESULTS

Participants reported a range of physical health consequences that they attributed to military service. These included injuries sustained during training and deployment, 'wear and tear' through training and the impact of sometimes unsuitable clothing. They reported chronic pain, tendonitis, arthritis, slipped discs, broken bones and hearing loss. Some described their lives as severely restricted as a result. Challenges to accessing healthcare included perceived stigma associated with help-seeking, inconsistency around the transfer of medical records and a widespread lack of veteran awareness among civilian healthcare professionals.

CONCLUSIONS

There is a distinct lack of research in the UK against which to compare these findings; thus, further research is required in all areas of female veterans' physical health and experiences of accessing healthcare. Research should begin by establishing the nature and prevalence of health conditions among female and male veterans to identify the unique needs of both and tailor support accordingly.

A Retrospective Cohort Analysis of Mental Health-Related Emergency Department Visits Among Veterans and Non-Veterans Residing in Ontario, Canada: Une analyse de cohorte rétrospective des visites au service d'urgence liées à la santé mentale parmi les vétérans et non-vétérans résidant en Ontario, Canada

OBJECTIVES

Emergency departments (EDs) are a vital part of healthcare systems, at times acting as a gateway to community-based mental health (MH) services. This may be particularly true for veterans of the Royal Canadian Mounted Police who were released prior to 2013 and the Canadian Armed Forces, as these individuals transition from federal to provincial healthcare coverage on release and may use EDs because of delays in obtaining a primary care provider. We aimed to estimate the hazard ratio (HR) of MH-related ED visits between veterans and non-veterans residing in Ontario, Canada: (1) overall; and by (2) sex; and (3) length of service.

METHODS

This retrospective cohort study used administrative healthcare data from 18,837 veterans and 75,348 age-, sex-, geography-, and income-matched non-veterans residing in Ontario, Canada between April 1, 2002, and March 31, 2020. Anderson-Gill regression models were used to estimate the HR of recurrent MH-related ED visits during the period of follow-up. Sex and length of service were used as stratification variables in the models.

RESULTS

Veterans had a higher adjusted HR (aHR) of MH-related ED visits than non-veterans (aHR, 1.97, 95% CI, 1.70 to 2.29). A stronger effect was observed among females (aHR, 3.29; 95% CI, 1.96 to 5.53) than males (aHR, 1.78; 95% CI, 1.57 to 2.01). Veterans who served for 5-9 years had a higher rate of use than non-veterans (aHR, 3.76; 95% CI, 2.34 to 6.02) while veterans who served for 30+ years had a lower rate compared to non-veterans (aHR, 0.60; 95% CI, 0.42 à 0.84).

CONCLUSIONS

Rates of MH-related ED visits are higher among veterans overall compared to members of the Ontario general population, but usage is influenced by sex and length of service. These findings indicate that certain subpopulations of veterans, including females and those with fewer years of service, may have greater acute mental healthcare needs and/or reduced access to primary mental healthcare.

Mental health services use among Canadian Armed Forces members and Veterans: Data from the 2018 Canadian Armed Forces members and Veterans mental health follow-up survey (CAFMVHS)

Background

Differences in healthcare delivery systems and pathways to mental healthcare for Canadian Armed Forces (CAF) members and Veterans may contribute to variations in mental health services use (MHSU) and the factors associated with it. We: (1) estimated the prevalence of past 12-month MHSU (≥1 visit with a medical or mental health professional); and (2) identified sociodemographic, military-, trauma-, and health-related variables associated with MHSU among CAF members and Veterans.

Methods

The current study used data from the 2018 CAF Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Model variables were selected a priori, and their respective associations with MHSU were estimated among (1) CAF members and (2) Veterans using separate multivariable logistic regression models.

Results

Similar proportions of CAF members and Veterans reported past 12-month MHSU (26.9 vs. 27.5%, respectively). For both CAF members and Veterans, meeting criteria for at least one past 12-month MH disorder was associated with past 12-month MHSU [adjusted odds ratio (AOR) = 7.80, 95% confidence interval (CI) = 7.18-8.46; and AOR = 11.82, 95% CI: 11.07-12.61, respectively). Past-year suicide ideation, a history of sexual trauma, and endorsement of adverse childhood experiences were also significantly associated with MHSU among CAF members and Veterans.

Significance

Similar to previous research, meeting screening criteria for a past 12-month MH disorder was strongly associated with MHSU among both samples. This study extends our existing knowledge about factors associated with MHSU among CAF members and Veterans, and offers direction for future research to increase MHSU.