Impact of VA Disability and Health Benefits on Long-Term Diabetes Outcomes among Vietnam-Era Veterans

退伍军人事务部残疾和健康福利对越战时期退伍军人长期糖尿病结局的影响

• 批准号: 10051323
• 负责人: AMAL N. TRIVEDI
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-11-01 至 2021-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10051323
• 关键词: Address; Adherence; Angiotensin-Converting Enzyme Inhibitors; Antidiabetic Drugs; Antihypertensive Agents; Area; Blood Glucose; Blood Pressure; Cambodia; Cardiovascular system; Caring; Chronic Disease; Complications of Diabetes Mellitus; Data; Diabetes Mellitus; Diagnosis; Disease Outcome; Economics; Eligibility Determination; Employment; Enrollment; Exposure to; Eye diseases; Financial compensation; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Government; Health; Health Benefit; Healthcare; Healthcare Systems; Herbicides; Hospitalization; Human Resources; Income; Individual; Injury; Institute of Medicine (U.S.); Intervention; Intervention Studies; Kidney Failure; Laos; Lipids; Low income; Lower Extremity; Medical; Medicare; Methods; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Oral; Outcome; Patients; Pharmaceutical Preparations; Policies; Quasi-experiment; Records; Research; Research Design; Retina; Role; Services; Suggestion; Sulfonylurea Compounds; Taxes; Testing; Time; Time trend; United States; Veterans; Vietnam; War; Work; agent orange; blood pressure regulation; cohort; copayment; cost; diabetes control; diabetic; disability; disability payment; experience; follow-up; food insecurity; health data; improved; innovation; limb amputation; macrovascular disease; medication compliance; meetings; member; military service; military veteran; mortality; neighborhood disadvantage; novel; payment; programs; service member; social determinants; social health determinants; socioeconomic disadvantage; study population

Anticipated Impacts on Veterans Health: This study will determine the extent to which disability compensation and more generous VA health benefits among Vietnam-era Veterans improved short and long- term outcomes of diabetes. This contribution is significant because one-quarter of VA enrollees have diabetes, and the complications related to diabetes account for substantial morbidity and spending among Veterans. Prior research suggests that intermediate and long-range outcomes in diabetes may be related to social determinants of health. We evaluate the health effects of a VA policy that directly intervenes on a key social determinant (income) among Veterans with diabetes. Project Background: In July 2001, the VA expanded the medical eligibility criteria for Vietnam-era Veterans to include diabetes as a service-connected condition. The change in policy was motivated by an Institute of Medicine (IOM) study of the association of Agent Orange, an herbicide used by the U.S. government during the Vietnam War, with the onset of type 2 diabetes. Specifically, any Veterans who had “boots on the ground” (BOG) in Vietnam, Cambodia, or Laos during the 1964 to 1975 period was deemed to be exposed to Agent Orange and therefore eligible for disability compensation and more generous health benefits, including zero medication copayments. The approximately 55% of Vietnam-era Veterans who did not have BOG during the war (Not on Ground (NOG)) were ineligible for disability compensation due to diabetes. Prior work by members of our research team found that the 2001 policy change led to a 30% relative increase in income for Veterans with BOG relative to their NOG counterparts. The value of these benefits is further enhanced because they are not subject to federal taxes and are made in perpetuity irrespective of other employment income. Project Objective: The overall objective of this application is to examine the impact of a major change in VA policy that led to increased disability compensation and health benefits for some, but not all, Vietnam-era Veterans with diabetes. We have the following specific aims: Aim 1. Examine whether increased benefits to Vietnam-era Veterans with diabetes resulted in better control of glycosylated hemoglobin (HbA1c) and blood pressure; and increased adherence to medications. Aim 2. Examine whether increased disability and health benefits to Vietnam-era Veterans with diabetes reduced micro- and macrovascular complications of diabetes. Aim 3. Examine whether more generous benefits to Vietnam-era Veterans with diabetes lowered mortality. Project Methods: Using a quasi-experimental study design that includes 15 years of follow-up data (2001- 2016), we will examine the effects of increased annual income as well as more generous health coverage on a comprehensive set of short and long-term outcomes of diabetes. Data on our main treatment variable, BOG status, will come from the Office of Economic Manpower Analysis (OEMA) of the U.S. Army. This data will be merged at the individual level with data on all Vietnam-era Army Veterans who are enrolled in the VA health care system as of July 2001. This data will provide us with detailed outcomes on medication adherence, glycosylated hemoglobin, blood pressure, diabetic complications, and mortality. Our study population will focus on Veterans with a diagnosis of diabetes prior to July 2001 to avoid the potential bias that eligible Veterans who had BOG may have been motivated to be diagnosed with diabetes after the policy change. In our primary study design, we propose to compare the change in the time trend in the BOG-NOG difference in outcomes before and after the policy change (2001 and prior years vs. 2002 and later years).

对退伍军人健康的预期影响：这项研究将确定残疾的程度 越战时期退伍军人的补偿和更慷慨的退伍军人事务部健康福利改善了短期和长期 这一贡献意义重大，因为四分之一的 VA 参与者患有糖尿病， 与糖尿病相关的并发症是退伍军人的大量发病率和支出的主要原因。 先前的研究表明，糖尿病的中期和长期结果可能与社交有关 我们评估直接干预关键社会的退伍军人事务部政策对健康的影响。 患有糖尿病的退伍军人的决定因素（收入）。 项目背景：2001 年 7 月，退伍军人管理局将越战退伍军人的医疗资格标准扩大到 将糖尿病纳入与服务相关的疾病中 政策的改变是由一个研究所推动的。 医学 (IOM) 对橙剂关联性的研究，橙剂是美国政府在 越南战争期间，随着 2 型糖尿病的出现，任何“脚踏实地”的退伍军人都受到了影响。 1964年至1975年期间在越南、柬埔寨或老挝（BOG）被视为接触过特工 橙色，因此有资格获得残疾赔偿和更慷慨的健康福利，包括零 大约 55% 的越战退伍军人在战争期间没有 BOG。 战争（不在地面（NOG））成员因糖尿病而没有资格获得伤残赔偿。 我们的研究小组发现，2001 年的政策变化导致退伍军人的收入相对增加了 30% 相对于 NOG 同类产品，BOG 的价值进一步增强，因为它们是 无需缴纳联邦税，并且无论其他就业收入如何，都是永久性的。 项目目标：此应用程序的总体目标是检查 VA 重大变化的影响 政策导致越南时期的一些人（但不是全部）增加伤残补偿和健康福利 我们有以下具体目标： 目标 1. 检查是否增加了对患有糖尿病的退伍军人的益处。 越战时期患有糖尿病的退伍军人更好地控制了糖化血红蛋白 (HbA1c) 和血液 目标 2. 检查是否增加了残疾和健康状况。 越战时期患有糖尿病的退伍军人的益处减少了糖尿病的微血管和大血管并发症。 目标 3：检查为越战时期患有糖尿病的退伍军人提供更慷慨的福利是否可以降低死亡率。 项目方法：采用准实验研究设计，其中包括 15 年的跟踪数据（2001- 2016），我们将研究年收入增加以及更慷慨的医疗保险对 关于我们的主要治疗变量 BOG 的全面的糖尿病短期和长期结果数据。 状态，将来自美国陆军经济人力分析办公室（OEMA）。 在个人层面与所有参加 VA 健康的越战时期退伍军人的数据合并 截至 2001 年 7 月的护理系统。这些数据将为我们提供有关药物依从性的详细结果， 我们的研究人群将重点关注糖化血红蛋白、血压、糖尿病并发症和死亡率。 2001 年 7 月之前诊断出糖尿病的退伍军人，以避免潜在的偏见，即合格的退伍军人 在我们的初选政策改变后，患有 BOG 的人可能会被诊断为糖尿病。 研究设计中，我们建议比较 BOG-NOG 结果差异的时间趋势变化 政策变更前后（2001 年及以前年份与 2002 年及以后年份）。