Exploring Health Outcomes for U.S. Veterans Compared to Non-Veterans from 2003 to 2019
Abstract
:1. Introduction
1.1. Stressors Associated with Military Service and Deployments
1.2. Operational Tempo (OPTEMPO)/Personnel Tempo (PERSTEMPO)
2. Materials and Methods
2.1. Data Source
2.2. Study Sample
2.3. Study Measures
2.3.1. Dependent Variables
2.3.2. Independent Variable
- Years 2003 through 2006 (Code: VETERAN). Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?” 1 = Yes, 2 = No, 7 = Don’t Know/Not Sure, 9 = Refused, Blank = Not asked/Missing.
- Years 2007 through 2008 (Code: VETERAN1). “Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.” 1 = Yes, 2 = No, 7 = Don’t Know/Not Sure, 9 = Refused, Blank = Not asked/Missing.
- Years 2009 (Code VETERAN2). “Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.” 1 = Yes, now on Active Duty, 2 = Yes, on Active Duty during the last 12 months but not now, 3 = Yes, on active duty in the past, but not during the last 12 months, 4 = No, training for Reserves or National Guard only, 5 = No, never served in the military, 7 = Don’t Know/Not Sure, 9 = Refused, Blank = Not asked/Missing.
- Years 2010 through 2019 (Code: VETERAN3). “Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.” 1 = Yes, 2 = No, 7 = Don’t Know/Not Sure, 9 = Refused, Blank = Not asked/Missing.
2.3.3. Covariates
Demographic Variables
Socio-Economic Variables
Geographic Variable
Time Variable
2.4. Methods and Models
2.4.1. Descriptive Models
2.4.2. General Linear Models
2.4.3. Data Analysis
3. Results
3.1. Descriptive Statistics
3.2. General Linear Models (GLMs)
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Year | Non-Vet Population | Vet Population | Population Estimate | Non-Vet Sample | Vet Sample | Total Sample |
---|---|---|---|---|---|---|
2003 | 190,348,049 | 30,003,072 | 220,351,121 | 228,159 | 36,525 | 264,684 |
2004 | 191,637,278 | 29,746,086 | 441,734,485 | 260,982 | 42,840 | 303,822 |
2005 | 194,578,583 | 29,532,523 | 445,494,470 | 305,107 | 51,005 | 356,112 |
2006 | 198,138,945 | 29,118,914 | 451,368,965 | 304,989 | 50,721 | 355,710 |
2007 | 202,498,717 | 27,673,461 | 457,430,037 | 370,990 | 59,922 | 430,912 |
2008 | 205,615,985 | 27,244,684 | 463,032,847 | 358,433 | 56,076 | 414,509 |
2009 | 208,756,506 | 26,249,349 | 467,866,524 | 374,909 | 57,698 | 432,607 |
2010 | 211,037,577 | 26,048,662 | 472,092,094 | 390,643 | 60,432 | 451,075 |
2011 | 212,198,501 | 25,812,791 | 475,097,531 | 441,873 | 64,594 | 506,467 |
2012 | 216,959,427 | 26,098,283 | 481,069,002 | 415,817 | 59,870 | 475,687 |
2013 | 219,968,409 | 26,056,006 | 489,082,125 | 430,268 | 61,505 | 491,773 |
2014 | 220,704,167 | 27,778,365 | 494,506,947 | 402,544 | 62,120 | 464,664 |
2015 | 224,174,518 | 27,172,620 | 499,829,670 | 383,614 | 57,842 | 441,456 |
2016 | 227,144,466 | 27,006,670 | 505,498,274 | 422,384 | 63,919 | 486,303 |
2017 | 229,254,924 | 26,398,281 | 509,804,341 | 392,148 | 57,868 | 450,016 |
2018 | 230,694,063 | 27,379,324 | 513,726,592 | 381,382 | 56,054 | 437,436 |
2019 | 226,740,688 | 25,689,603 | 510,503,678 | 365,038 | 53,230 | 418,268 |
Totals | 3,610,450,803 | 465,008,694 | 7,898,488,703 | 6,229,280 | 952,221 | 7,181,501 |
Type | Name | |
---|---|---|
Dependent Variable: Overweight/Obese | _RFBMI5 | Adults who have a body mass index greater than 25.00. No, Yes, Don’t Know/Refused/Missing |
Dependent Variable: Angina or coronary heart disease | CVDCRHD# | (Ever told) you had angina or coronary heart disease? Yes, No, Don’t Know/Not Sure, Not Asked/Missing |
Dependent Variable: Stroke | CVDSTRK# | (Ever told) you had a stroke. Yes, No, Don’t Know/Not Sure, Not Asked/Missing |
Dependent Variable: Skin cancer | CHCSNCR | (Ever told) you had skin cancer? Yes, No, Don’t Know/Not Sure, Not Asked/Missing |
Dependent Variable: Other cancer | CHCOCNCR | (Ever told) you had any other types of cancer? Yes, No, Don’t Know/Not Sure, Not Asked/Missing |
Dependent Variable: COPD | CHCCOPD# | (Ever told) (you had) C.O.P.D., emphysema or chronic bronchitis? Yes, No, Don’t Know/Not Sure, Not Asked/Missing |
Dependent Variable: Arthritis | HAVARTH# | Ever told) (you had) some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? Yes, No, Don’t Know/Not Sure, Not Asked/Missing |
Dependent Variable: Mental Health | MENTHLTH | Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? Number of Days, None, Don’t Know/Not Sure, Refused, Not Asked/Missing |
Dependent Variable: Kidney Disease | CHCKDNY | Not including kidney stones, bladder infection or incontinence, were you ever told you had kidney disease? Yes, No, Don’t Know/Not Sure, Not Asked/Missing |
Dependent Variable: Diabetes | DIABETE# | (Ever told) (you had) diabetes? Yes, Yes Gestational Only, No, No Pre-Diabetes, Don’t Know/Not Sure, Refused, Not Asked/Missing (Recoded to Yes Non-Gestational, No, Unknown) |
Demographic Control: Age | _AGE_G | Six-level imputed age category: 18–24, 25–34, 35–44, 45–54, 55–64, 65+ |
Demographic Control: Race | _IMPRACE | Imputed race/ethnicity value: White Non-Hispanic, Black Non-Hispanic, Asian Non-Hispanic, American Indian/Alaska Native Non-Hispanic, Hispanic, Other Race Non-Hispanic |
Demographic Control: Gender | SEX | Calculated sex variable: Birth Sex Male, Birth Sex Female |
Demographic Control: Marital Status | MARITAL | Are you: Married, Divorced, Widowed, Separated, Never Married, Unmarried Couple, Refused, Not Asked/Missing |
Socioeconomic Control: Income | INCOME# | Is your annual household income from all sources: <$10 K, <$15 K, <$20 K, <$25 K, <$35 K, <$50 K, <$75 K, $75 K+, Don’t Know/Not Sure, Refused, Not Asked/Missing |
Socioeconomic Control: Education | EDUCA | Level of education completed: < High School, Graduated High School, Attended College/Technical School, Graduated College/Technical School, Don’t Know/Not Sure/Missing |
Socioeconomic Control: Employment | EMPLOY# | Are you currently…? Employed for Wages, Self-Employed, Out of Work 1+ Years, Out of Work <1 Year, A Homemaker, A Student, Retired, Unable to Work, Refused, Not Asked/Missing |
Geographical control: State | _STATE | Federal Information Processing Standard Code for State |
Independent Variable: Veteran Status | VETERAN# | Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? |
Weighting Variable | _STSTR | Sample Design Stratification Variable |
Weighting Variable | _LLCPWT | Final weight assigned to each respondent |
Question * | Yes | No | Unknown |
---|---|---|---|
Overweight/Obese | 62%/60% | 29%/30% | 9%/10% + |
Coronary Heart Disease | 6%/4% | 93%/95% | 1%/1% |
Stroke | 4%/3% | 95%/96% | 1%/1% |
Skin Cancer | 10%/6% | 90%/93% | 0%/0% |
Other Cancer | 10%/7% | 90%/93% | 0%/0% |
COPD | 8%/7% | 91%/93% | 1%/0% |
Arthritis | 33%/25% | 66%/75% | 1%/0% |
Mental Health | 34%/37% | 66%/63% | 0%/0% |
Kidney Issues | 4%/3% | 96%/97% | 0%/0% |
Diabetes | 14%/11% | 86%/89% | 0%/0% |
Variable | Year |
---|---|
Overweight/Obese | 2003 |
Heart Disease | 2005 |
Stroke | 2005 |
Skin Cancer | 2011 |
Cancer | 2011 |
COPD | 2011 |
Arthritis | 2011 |
Mental Health | 2003 |
Kidney Disease | 2011 |
Diabetes | 2003 |
Obesity | Diabetes | Mental Health | Heart Disease | Stroke | Skin Cancer | Cancer | COPD | Arthritis | Kidney Disease | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Year * | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet | Non-Vet | Vet |
Y2003 | 0.56 | 0.70 | 0.11 | 0.13 | 0.37 | 0.31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2004 | 0.57 | 0.70 | 0.12 | 0.13 | 0.37 | 0.31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2005 | 0.58 | 0.70 | 0.13 | 0.14 | 0.36 | 0.30 | 0.08 | 0.13 | 0.05 | 0.06 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2006 | 0.58 | 0.71 | 0.13 | 0.15 | 0.37 | 0.30 | 0.08 | 0.14 | 0.05 | 0.06 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2007 | 0.59 | 0.72 | 0.14 | 0.16 | 0.36 | 0.28 | 0.08 | 0.13 | 0.05 | 0.06 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2008 | 0.60 | 0.73 | 0.14 | 0.15 | 0.36 | 0.30 | 0.08 | 0.14 | 0.05 | 0.06 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2009 | 0.60 | 0.73 | 0.14 | 0.16 | 0.36 | 0.30 | 0.07 | 0.13 | 0.05 | 0.06 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2010 | 0.61 | 0.73 | 0.14 | 0.16 | 0.36 | 0.30 | 0.08 | 0.14 | 0.05 | 0.06 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Y2011 | 0.60 | 0.73 | 0.15 | 0.18 | 0.37 | 0.30 | 0.08 | 0.13 | 0.05 | 0.06 | 0.11 | 0.16 | 0.11 | 0.13 | 0.08 | 0.09 | 0.37 | 0.36 | 0.03 | 0.03 |
Y2012 | 0.60 | 0.72 | 0.15 | 0.18 | 0.37 | 0.30 | 0.08 | 0.13 | 0.05 | 0.06 | 0.11 | 0.16 | 0.11 | 0.12 | 0.08 | 0.09 | 0.38 | 0.38 | 0.04 | 0.04 |
Y2013 | 0.60 | 0.72 | 0.16 | 0.18 | 0.35 | 0.29 | 0.08 | 0.13 | 0.05 | 0.06 | 0.11 | 0.16 | 0.11 | 0.16 | 0.08 | 0.10 | 0.38 | 0.37 | 0.04 | 0.04 |
Y2014 | 0.59 | 0.72 | 0.16 | 0.18 | 0.35 | 0.29 | 0.08 | 0.13 | 0.05 | 0.06 | 0.11 | 0.17 | 0.11 | 0.12 | 0.09 | 0.10 | 0.39 | 0.37 | 0.04 | 0.04 |
Y2015 | 0.59 | 0.71 | 0.16 | 0.19 | 0.36 | 0.30 | 0.07 | 0.12 | 0.05 | 0.06 | 0.12 | 0.17 | 0.12 | 0.13 | 0.08 | 0.10 | 0.37 | 0.37 | 0.04 | 0.04 |
Y2016 | 0.59 | 0.71 | 0.17 | 0.19 | 0.36 | 0.30 | 0.08 | 0.12 | 0.05 | 0.06 | 0.11 | 0.16 | 0.11 | 0.13 | 0.08 | 0.10 | 0.38 | 0.38 | 0.04 | 0.05 |
Y2017 | 0.59 | 0.71 | 0.17 | 0.19 | 0.38 | 0.31 | 0.07 | 0.12 | 0.05 | 0.06 | 0.12 | 0.17 | 0.12 | 0.14 | 0.09 | 0.11 | 0.37 | 0.37 | 0.04 | 0.05 |
Y2018 | 0.60 | 0.72 | 0.17 | 0.20 | 0.39 | 0.32 | 0.07 | 0.12 | 0.05 | 0.07 | 0.12 | 0.17 | 0.12 | 0.14 | 0.09 | 0.11 | 0.38 | 0.39 | 0.05 | 0.05 |
Y2019 | 0.60 | 0.71 | 0.17 | 0.19 | 0.41 | 0.35 | 0.07 | 0.11 | 0.05 | 0.07 | 0.12 | 0.18 | 0.12 | 0.14 | 0.09 | 0.11 | 0.37 | 0.37 | 0.05 | 0.05 |
Y11-Y19 | 0.60 | 0.72 | 0.16 | 0.19 | 0.37 | 0.30 | 0.08 | 0.13 | 0.05 | 0.06 | 0.11 | 0.16 | 0.11 | 0.13 | 0.09 | 0.10 | 0.38 | 0.37 | 0.04 | 0.04 |
Variable | Overweight/Obese | Heart Disease | Stroke | Skin Cancer | Cancer | COPD | Arthritis | Mental Health | Kidney Disease | Diabetes |
---|---|---|---|---|---|---|---|---|---|---|
(Intercept) | 0.478 *** | 0.004 *** | 0.007 *** | 0.001 *** | 0.009 *** | 0.035 *** | 0.055 *** | 1.356 *** | 0.012 *** | 0.015 *** |
25 to 34 | 2.010 *** | 2.074 *** | 2.753 *** | 1.504 *** | 2.663 *** | 1.834 *** | 2.87 *** | 0.915 *** | 1.728 *** | 2.402 *** |
35 to 44 | 2.827 *** | 4.645 *** | 5.724 *** | 3.518 *** | 4.340 *** | 2.863 *** | 6.354 *** | 0.844 *** | 2.765 *** | 6.931 *** |
45 to 54 | 3.305 *** | 11.432 *** | 10.822 *** | 8.587 *** | 7.742 *** | 4.831 *** | 13.269 *** | 0.748 *** | 4.158 *** | 15.439 *** |
55 to 64 | 3.526 *** | 21.610 *** | 15.455 *** | 15.812 *** | 12.604 *** | 6.285 *** | 22.293 *** | 0.587 *** | 5.744 *** | 25.632 *** |
65 or older | 3.111 *** | 32.13 *** | 19.386 *** | 33.477 *** | 21.72 *** | 5.484 *** | 27.973 *** | 0.283 *** | 7.123 *** | 30.954 *** |
Caucasian | 0.960 *** | 1.128 *** | 0.768 *** | 6.149 *** | 1.342 *** | 1.291 *** | 1.205 *** | 1.235 *** | 0.864 *** | 0.596 *** |
Hispanic | 1.155 *** | 0.906 *** | 0.655 *** | 1.171 *** | 0.812 *** | 0.653 *** | 0.693 *** | 0.903 *** | 1.033 | 1.013 |
Male | 1.889 *** | 1.676 *** | 1.093 *** | 1.058 *** | 0.618 *** | 0.816 *** | 0.664 *** | 0.648 *** | 0.948 *** | 1.212 *** |
Married | 1.072 *** | 0.877 *** | 0.718 *** | 1.086 *** | 0.953 *** | 0.643 *** | 0.850 *** | 0.677 *** | 0.833 *** | 0.943 *** |
Income ≥ $75K | 1.044 *** | 0.749 *** | 0.579 *** | 1.180 *** | 0.953 *** | 0.515 *** | 0.794 *** | 0.836 *** | 0.759 *** | 0.694 *** |
College Graduate | 0.689 *** | 0.739 *** | 0.639 *** | 1.249 *** | 1.016 + | 0.473 *** | 0.671 *** | 0.949 *** | 0.789 *** | 0.661 *** |
Employed for Wages | 1.186 *** | 0.472 *** | 0.351 *** | 0.78 *** | 0.651 *** | 0.46 *** | 0.613 *** | 0.756 *** | 0.473 *** | 0.663 *** |
East North Central | 1.076 *** | 1.217 *** | 1.283 *** | 1.48 *** | 1.037 * | 1.297 *** | 1.157 *** | 0.882 *** | 1.016 | 1.203 *** |
East South Central | 0.817 *** | 0.999 | 0.869 *** | 0.977 | 0.986 | 0.887 *** | 0.899 *** | 0.928 *** | 0.839 *** | 0.934 *** |
Middle Atlantic | 0.787 *** | 0.802 *** | 0.885 *** | 1.476 *** | 0.994 | 0.840 *** | 0.849 *** | 0.961 *** | 1.039 + | 0.832 *** |
Mountain | 0.790 *** | 0.890 *** | 0.840 *** | 1.062 *** | 1.039 ** | 0.870 *** | 0.894 *** | 0.976 ** | 0.877 *** | 0.892 *** |
Pacific | 0.743 *** | 0.843 *** | 0.845 *** | 1.417 *** | 1.027 | 0.766 *** | 0.790 *** | 1.035 *** | 0.968 | 0.883 *** |
South Atlantic | 0.883 *** | 1.022 | 1.027 | 1.562 *** | 0.996 | 1.022 + | 0.905 *** | 0.853 *** | 0.982 | 0.990 |
West North Central | 0.986 | 1.975 *** | 0.597 *** | 0.89 * | 0.902 ** | 0.785 *** | 1.025 | 0.553 *** | 0.745 *** | 0.976 |
West South Central | 0.961 *** | 0.913 *** | 0.976 | 1.067 *** | 0.998 | 0.849 *** | 0.849 *** | 0.808 *** | 0.86 *** | 0.935 *** |
Territories of U.S | 0.980 + | 1.052* | 1.107 *** | 1.306 *** | 0.979 | 0.962 * | 0.873 *** | 0.845 *** | 1.044 | 1.08 *** |
Veteran | 1.239 *** | 1.34 *** | 1.276 *** | 1.302 *** | 1.509 *** | 1.355 *** | 1.247 *** | 0.972 ** | 1.152 *** | 1.108 *** |
Year 2012 | 1.009 | 1.048 ** | 0.988 | 0.961 ** | 0.976 | 1.029 + | 1.069 *** | 1.011 | 1.061 * | 1.04 ** |
Year 2013 | 1.006 | 0.956 * | 0.998 | 0.999 | 1.006 | 1.049 ** | 1.022 * | 0.939 *** | 1.047 + | 1.04 ** |
Year 2014 | 0.974 ** | 0.992 | 1.045 * | 0.979 | 0.974 + | 1.069 *** | 1.054 *** | 0.941 *** | 1.093 *** | 1.066 *** |
Year 2015 | 0.956 *** | 0.904 *** | 1.029 | 1.000 | 1.003 | 1.019 | 0.988 | 0.97 ** | 1.054 * | 1.055 *** |
Year 2016 | 0.960 *** | 0.965 * | 1.076 ** | 0.990 | 0.988 | 1.067 *** | 1.034 *** | 0.982 * | 1.163 *** | 1.088 *** |
Year 2017 | 0.982 * | 0.89 *** | 1.087 *** | 0.989 | 1.018 | 1.076 *** | 0.972 ** | 1.043 *** | 1.243 *** | 1.102 *** |
Year 2018 | 1.000 | 0.958 * | 1.156 *** | 1.013 | 1.020 | 1.142 *** | 1.056 *** | 1.076 *** | 1.224 *** | 1.165 *** |
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Betancourt, J.A.; Granados, P.S.; Pacheco, G.J.; Reagan, J.; Shanmugam, R.; Topinka, J.B.; Beauvais, B.M.; Ramamonjiarivelo, Z.H.; Fulton, L.V. Exploring Health Outcomes for U.S. Veterans Compared to Non-Veterans from 2003 to 2019. Healthcare 2021, 9, 604. https://doi.org/10.3390/healthcare9050604
Betancourt JA, Granados PS, Pacheco GJ, Reagan J, Shanmugam R, Topinka JB, Beauvais BM, Ramamonjiarivelo ZH, Fulton LV. Exploring Health Outcomes for U.S. Veterans Compared to Non-Veterans from 2003 to 2019. Healthcare. 2021; 9(5):604. https://doi.org/10.3390/healthcare9050604
Chicago/Turabian StyleBetancourt, Jose A., Paula Stigler Granados, Gerardo J. Pacheco, Julie Reagan, Ramalingam Shanmugam, Joseph B. Topinka, Bradley M. Beauvais, Zo H. Ramamonjiarivelo, and Lawrence V. Fulton. 2021. "Exploring Health Outcomes for U.S. Veterans Compared to Non-Veterans from 2003 to 2019" Healthcare 9, no. 5: 604. https://doi.org/10.3390/healthcare9050604