Gender and the Use of Veterans Health Administration Homeless Services Programs Among Iraq/Afghanistan Veterans : Medical Care

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Gender and the Use of Veterans Health Administration Homeless Services Programs Among Iraq/Afghanistan Veterans

Blackstock, Oni J. MD*,†,‡; Haskell, Sally G. MD*,‡; Brandt, Cynthia A. MD, MPH‡,§; Desai, Rani A. PhD, MPH†,∥,¶

Author Information

*Department of Internal Medicine

†Robert Wood Johnson Foundation Clinical Scholars Program

‡Department of Medicine/VA Connecticut Healthcare System

§Yale Center for Medical Informatics

∥VISN 1 MIRECC/VA Connecticut Healthcare System

Department of Psychiatry, Yale School of Medicine, New Haven, CT

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.lww-medicalcare.com.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

Funders: VA HSR&D grant DHI 07-065-1, Robert Wood Johnson Foundation Clinical Scholars Program, and Department of Veterans Affairs/VA Connecticut Healthcare System.

Role of the Funding Sources: The funding sources had no role in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

The authors declare no conflict of interest.

Reprints: Oni J. Blackstock, MD, Robert Wood Johnson Foundation Clinical Scholars, Yale School of Medicine, 333 Cedar Street, SHM IE-61, New Haven, CT 06520-8088. E-mail: [email protected].

Medical Care 50(4):p 347-352, April 2012. | DOI: 10.1097/MLR.0b013e318245a738

Abstract

Background: 

Female Veterans comprise 12% of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, the largest proportion of women to serve of any prior cohort. We sought to determine the sex-specific risk of using a Veterans Health Administration (VHA) homeless program among OEF/OIF Veterans and to identify factors associated with increased risk of program use for women compared with men.

Methods: 

We included OEF/OIF Veterans with at least 1 VHA clinical visit between October 1, 2001, and September 30, 2009. The study’s outcome was the time to first use of a VHA homeless program. Cox proportional-hazards regression was used to estimate the relative risk of using a homeless program by sex, adjusting for relevant sociodemographic and clinical variables. Exploratory analyses examined interactions between sex and all covariates.

Results: 

Of 445,319 Veterans, 7431 (1.7%) used a VHA homeless program, of which 961 were females (1.8%), and 6470 were males (1.7%) during a median follow-up period of 3.20 years. Women were as likely as men to use a homeless program (adjusted hazard ratio, 1.02; 95% confidence interval, 0.95–1.09); median time to first use was similar for female and male Veterans (1.88 vs. 1.88 y, respectively, P=0.53). In exploratory analyses, we found increased risk of program use for women compared with men for the following subgroups: ages 26–35 years, 100% service-connected disability rating, posttraumatic stress disorder diagnosis, and northeast location.

Conclusions: 

Overall, there was no substantial difference in the sex-specific risk of using a VHA homeless program. In light of this finding, VHA homeless programs must be prepared to recognize and address the unique needs of female OEF/OIF Veterans.

© 2012 Lippincott Williams & Wilkins, Inc.

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