Healthcare Disparities among American Indian Veterans in the U.S.: A Population-Based Study

Pamela Jo Johnson, Kathleen F Carlson, Mary O Hearst

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To examine healthcare coverage and access disparities for American Indian/Alaska Native (AIAN) veterans compared with non-Hispanic white veterans. METHODS: We examined national survey data for honorably discharged veterans in the United States using National Health Interview Survey (NHIS) data between 1997 and 2006. NHIS data were obtained from the Integrated Health Interview Series, a web-based data resource containing harmonized NHIS data from 1969 to the present. Our sample included AIAN and white veterans aged 18 to 64 years (n = 34,504). We used multivariate logistic regression models to estimate the odds of being uninsured, reasons for delayed care, and types of foregone care. RESULTS: In multivariate analysis, AIAN veterans have 1.9 times higher odds of being uninsured compared with non-Hispanic white veterans (95% CI: 1.6-2.7). Compared with white veterans, AIAN veterans are significantly more likely to delay care due to not getting timely appointments (OR = 2.0, 95% CI: 1.1-2.6), not getting through on the phone (OR = 3.0, 95% CI: 1.6-5.8), and transportation problems (OR = 2.9, 95% CI: 1.1-7.3). In unadjusted models, AIAN veterans have significantly higher odds of having foregone 4 of 5 types of care compared with non-Hispanic white veterans. Adjusting for sociodemographic characteristics and insurance eliminated all significant relations. CONCLUSIONS: AIAN veterans have considerable disparities in healthcare coverage and access compared with non-Hispanic whites. Although barriers to care due to cost are nominal for AIAN veterans, barriers to care due to navigating the healthcare system and due to lack of transportation remain substantial.
Original languageEnglish (US)
Pages (from-to)563-569
Number of pages7
JournalMedical Care
Volume48
Issue number6
StatePublished - 2010

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Healthcare Disparities
North American Indians
Veterans
Population
Health Surveys
Interviews
Logistic Models
Delivery of Health Care
Alaska Natives
Insurance

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Healthcare Disparities among American Indian Veterans in the U.S.: A Population-Based Study. / Johnson, Pamela Jo; Carlson, Kathleen F; Hearst, Mary O.

In: Medical Care, Vol. 48, No. 6, 2010, p. 563-569.

Research output: Contribution to journalArticle

Johnson, Pamela Jo ; Carlson, Kathleen F ; Hearst, Mary O. / Healthcare Disparities among American Indian Veterans in the U.S.: A Population-Based Study. In: Medical Care. 2010 ; Vol. 48, No. 6. pp. 563-569.
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abstract = "OBJECTIVE: To examine healthcare coverage and access disparities for American Indian/Alaska Native (AIAN) veterans compared with non-Hispanic white veterans. METHODS: We examined national survey data for honorably discharged veterans in the United States using National Health Interview Survey (NHIS) data between 1997 and 2006. NHIS data were obtained from the Integrated Health Interview Series, a web-based data resource containing harmonized NHIS data from 1969 to the present. Our sample included AIAN and white veterans aged 18 to 64 years (n = 34,504). We used multivariate logistic regression models to estimate the odds of being uninsured, reasons for delayed care, and types of foregone care. RESULTS: In multivariate analysis, AIAN veterans have 1.9 times higher odds of being uninsured compared with non-Hispanic white veterans (95{\%} CI: 1.6-2.7). Compared with white veterans, AIAN veterans are significantly more likely to delay care due to not getting timely appointments (OR = 2.0, 95{\%} CI: 1.1-2.6), not getting through on the phone (OR = 3.0, 95{\%} CI: 1.6-5.8), and transportation problems (OR = 2.9, 95{\%} CI: 1.1-7.3). In unadjusted models, AIAN veterans have significantly higher odds of having foregone 4 of 5 types of care compared with non-Hispanic white veterans. Adjusting for sociodemographic characteristics and insurance eliminated all significant relations. CONCLUSIONS: AIAN veterans have considerable disparities in healthcare coverage and access compared with non-Hispanic whites. Although barriers to care due to cost are nominal for AIAN veterans, barriers to care due to navigating the healthcare system and due to lack of transportation remain substantial.",
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N2 - OBJECTIVE: To examine healthcare coverage and access disparities for American Indian/Alaska Native (AIAN) veterans compared with non-Hispanic white veterans. METHODS: We examined national survey data for honorably discharged veterans in the United States using National Health Interview Survey (NHIS) data between 1997 and 2006. NHIS data were obtained from the Integrated Health Interview Series, a web-based data resource containing harmonized NHIS data from 1969 to the present. Our sample included AIAN and white veterans aged 18 to 64 years (n = 34,504). We used multivariate logistic regression models to estimate the odds of being uninsured, reasons for delayed care, and types of foregone care. RESULTS: In multivariate analysis, AIAN veterans have 1.9 times higher odds of being uninsured compared with non-Hispanic white veterans (95% CI: 1.6-2.7). Compared with white veterans, AIAN veterans are significantly more likely to delay care due to not getting timely appointments (OR = 2.0, 95% CI: 1.1-2.6), not getting through on the phone (OR = 3.0, 95% CI: 1.6-5.8), and transportation problems (OR = 2.9, 95% CI: 1.1-7.3). In unadjusted models, AIAN veterans have significantly higher odds of having foregone 4 of 5 types of care compared with non-Hispanic white veterans. Adjusting for sociodemographic characteristics and insurance eliminated all significant relations. CONCLUSIONS: AIAN veterans have considerable disparities in healthcare coverage and access compared with non-Hispanic whites. Although barriers to care due to cost are nominal for AIAN veterans, barriers to care due to navigating the healthcare system and due to lack of transportation remain substantial.

AB - OBJECTIVE: To examine healthcare coverage and access disparities for American Indian/Alaska Native (AIAN) veterans compared with non-Hispanic white veterans. METHODS: We examined national survey data for honorably discharged veterans in the United States using National Health Interview Survey (NHIS) data between 1997 and 2006. NHIS data were obtained from the Integrated Health Interview Series, a web-based data resource containing harmonized NHIS data from 1969 to the present. Our sample included AIAN and white veterans aged 18 to 64 years (n = 34,504). We used multivariate logistic regression models to estimate the odds of being uninsured, reasons for delayed care, and types of foregone care. RESULTS: In multivariate analysis, AIAN veterans have 1.9 times higher odds of being uninsured compared with non-Hispanic white veterans (95% CI: 1.6-2.7). Compared with white veterans, AIAN veterans are significantly more likely to delay care due to not getting timely appointments (OR = 2.0, 95% CI: 1.1-2.6), not getting through on the phone (OR = 3.0, 95% CI: 1.6-5.8), and transportation problems (OR = 2.9, 95% CI: 1.1-7.3). In unadjusted models, AIAN veterans have significantly higher odds of having foregone 4 of 5 types of care compared with non-Hispanic white veterans. Adjusting for sociodemographic characteristics and insurance eliminated all significant relations. CONCLUSIONS: AIAN veterans have considerable disparities in healthcare coverage and access compared with non-Hispanic whites. Although barriers to care due to cost are nominal for AIAN veterans, barriers to care due to navigating the healthcare system and due to lack of transportation remain substantial.

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