Abstract
More women than ever are serving in the military. Currently, women account for 17% of active duty service members. 1 By the year 2045, it is projected that 20% of all U.S. veterans will be women. 2 At the same time, the number of women veterans seeking care in the Veterans Administration (VA) health care system is rapidly growing. Women veterans utilizing care in VA have grown threefold from 159,810 in fiscal year 2000 to 439,791 in fiscal year 2015. 3 Given that the VA's health care system was originally designed for a predominately male veteran population, it is essential that VA's policies and health care delivery planning be accurately informed to ensure female veterans have access to equitable high-quality care that is tailored to their unique needs. Gender-based and biological differences between men and women can result in differences in health risks, incidence of disease, health outcomes, and health service needs. 4 These differences may result in unmet health care needs among women if not fully understood or incorporated in a male-dominated health care system. Thus, determining these gender differences among VA patients is essential to implement the appropriate models of health care delivery for women veterans.
In this issue of the Journal of Women's Health, Gaffey et al. 5 present baseline data from the Women Veteran Cohort Study (WVCS), the first longitudinal prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans. These data include demographics, military service, health risk factors, medical history, as well as health care utilization, access, and insurance coverage that was collected by various survey instruments from both male and female veterans who used VA health care at one of five VA medical centers in 2016. This survey is the second “wave” of the WVCS (the first “wave” of the WVCS was conducted from 2008 to 2011) and was designed to include additional questions on health conditions, such as cardiovascular, musculoskeletal, or mental health that may have gender-specific manifestations. The goal of the WVCS is to better understand the unique needs of women veterans by identifying gender disparities in OEF/OIF/OND veteran health outcomes and health care utilization patterns to better inform the VA on how to provide the highest quality care for this female population now and in the future.
Results from this study found that female OEF/OIF/OND veterans were younger, more diverse, and more educated, but poorer, and less likely to own their residence than their male counterparts. Female respondents reported less combat exposure and social support from their fellow unit members than their male counterparts, but more of them reported a history of military sexual trauma (MST [10 × that of male veterans]) and lower resilience. A greater majority of female veterans reported fair or poor health than male veterans (28% vs. 23%), and a majority of both male and females (75%) reported experiencing chronic pain, however, females reported more sites of pain. A greater percentage of male than female veterans reported having been treated for hypertension and diabetes, but a significantly greater percentage of females reported treatment for depression, anxiety, and other emotional disorders. A high percentage of both male and female respondents reported that they have received medical treatment in the previous 12 months, with a higher percentage of females reporting four or more medical visits in that period.
This study provides further evidence that OEF/OIF/OND women veterans are experiencing different risk factors for chronic conditions, different health outcomes, and different health care utilization than their male counterparts, which may impact how future and current health care services should be planned and delivered to them by the VA. For example, although a high percentage of both male and female veterans report chronic pain, male veterans are more likely to be treated with interventional techniques, whereas female veterans are more likely to be prescribed opioids. The study authors suggest that determining underlying risk factors for pain conditions in women veterans and alternative therapeutic strategies such as early exercise, weight reduction, and social support is needed to provide the best care. In addition, this female veteran cohort reported a greater prevalence of nontraditional cardiovascular risk factors such as MST, depression, and anxiety than their male counterparts and as such should be a focus of future research to determine surveillance strategies and potential preventative interventions to mitigate cardiovascular disease as well as other chronic conditions in this unique population. The strengths of this study include representation from geographically diverse study sites and alignment with findings from previous studies of OEF/OIF/OND women veterans, electronic health record data, as well as studies of the national population of women veterans.