Structural racism in the United States (US) has long contributed to health disparities in minoritized communities through reduced health care access and economic inequities. The COVID-19 pandemic exacerbated these issues, with racial and ethnic minorities experiencing higher rates of severe illness, job loss, and poor living conditions.
The Veterans Health Administration (VHA), serving over nine million Veterans, is becoming more ethnically and racially diverse. In addition, VHA enrollees tend to have a higher number of comorbidities and higher risk for severe COVID-19 illness compared to the general US population. Previous work found that minoritized Veterans were disproportionately affected by excess mortality during the COVID-19 pandemic, but that work did not account for Veterans’ underlying health status such as group-level differences in comorbidity burden.
New Research:
In the study, “Racial and ethnic disparities in excess mortality among US Veterans during the COVID-19 pandemic,” researchers at the Partnered Evidence-based Policy Resource Center (PEPReC) examined how the pandemic may have disproportionately affected Veterans from different racial and ethnic backgrounds. To understand the impact on minoritized communities, PEPReC researchers expanded on existing work, using a longer time period and a previously validated approach to identify excess mortality attributable to the COVID-19 pandemic. Excess mortality refers to the number of deaths for a specific time (i.e., pandemic) that is above what would be expected based on historical averages.
Methods:
PEPReC researchers queried nationwide data from VHA’s Corporate Data Warehouse for Veteran demographics (e.g., race/ethnicity, age) and other characteristics that were previously associated with mortality risk (e.g., service-connected disabilities, major comorbidities). A validated mortality risk prediction model was leveraged to estimate the expected mortality among Veterans, using five years of pre-pandemic data and controlling for disease burden. Once established, the model was then used to generate predicted Veteran mortality for the pandemic period (March to December 2020) specifically, along with estimating excess mortality for each race/ethnicity group.
Findings:
To populate the mortality risk prediction model, the researchers analyzed data from about 9.3 million unique Veterans seeking care at VHA between 2016 and 2020, excluding those with missing race/ethnicity or county information.
For the pandemic period, March to December 2020, they observed monthly enrollment of 7.8 million Veterans and 261,523 Veteran deaths. Overall, Veterans’ mortality rates were 16% above normal during the pandemic period, equating to 42,348 excess deaths.
Excess mortality rates increased significantly for particular racial and ethnic groups as well. Native American, Black, and Hispanic Veterans faced significantly higher excess mortality rates (40%, 32%, and 26%, respectively), compared to the lowest calculated excess mortality rate in non-Hispanic White Veterans (17%). However, these disparities in VHA were smaller than what is seen in the general US population.
Conclusion:
The study’s findings reflect the broader societal inequities exacerbated by the pandemic. To address these issues in VHA, it is essential to expand health care services in underserved areas and increase funding for Veteran-specific programs that improve access to care. Expanding VHA’s telehealth services, which have successfully reached minority Veterans in remote or rural areas, is one effective strategy to ensure timely medical attention.
Implementing targeted interventions, such as community outreach and culturally competent care, could also help reduce disparities and improve health outcomes for minority Veterans. Provider training programs on cultural competency have been shown to enhance patient-provider interactions and care quality.
During the COVID-19 pandemic, VHA observed racial and ethnic disparities in excess mortality, with minoritized Veterans dying at higher rates compared to White Veterans. While progress has been made in addressing structural racism within VHA, further improvements in care quality, delivery, and access are needed, especially for communities of color.
