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 越南退伍军人的薪酬和更慷慨的VA健康益处改善了短期和长期 糖尿病的术语结果。这项贡献很重要，因为四分之一的VA注册者患有糖尿病， 与糖尿病有关的并发症解释了退伍军人之间的大量发病率和支出。 先前的研究表明，糖尿病中的中间和长期结局可能与社会有关 健康的决定因素。我们评估了直接介入关键社会的VA政策的健康影响 糖尿病退伍军人的决定因素（收入）。 项目背景：2001年7月，VA扩大了越南退伍军人的医疗资格标准 包括糖尿病作为服务相互连接的疾病。政策的变化是由 医学（IOM）对特工橙协会的研究，橙色协会是美国政府在美国政府使用的一种除草剂 越南战争，有2型糖尿病的发作。具体而言，任何“地面靴子”的退伍军人 （BOG）在1964年至1975年期间，在越南，柬埔寨或老挝被视为暴露于代理商 橙色，因此有资格获得残疾补偿和更慷慨的健康益处，包括零 药物共生。在没有沼泽的越南时代的退伍军人中约有55％ 战争（不在地面（NOG））没有资格获得糖尿病引起的残疾补偿。成员的事先工作 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％ 与沼泽相对于他们的Nog对应物。这些利益的价值进一步增强了，因为它们是 不缴纳联邦税，无论其他就业收入如何，都会永久征收。 项目目标：本应用程序的总体目标是检查VA的重大变化的影响 政策导致某些但不是全部的残疾赔偿和健康益处增加的政策 患有糖尿病的退伍军人。我们有以下具体目标：目标1。检查是否增加了对 越南时代的糖尿病退伍军人可以更好地控制糖基化血红蛋白（HBA1C）和血液 压力;并增加了对药物的依从性。目标2。检查是否增加残疾和健康 糖尿病降低糖尿病的越南退伍军人的好处。 目标3。检查越南时代的退伍军人是否更慷慨的益处降低了死亡率。 项目方法：使用包括15年后续数据的准实验研究设计（2001-- 2016年），我们将研究增加年收入的影响以及更慷慨的健康覆盖范围 全面的糖尿病短期和长期结局。有关我们主要治疗变量的数据，沼泽 地位将来自美国陆军经济人力分析办公室（OEMA）。这些数据将是 在各个层面上与所有越南陆军退伍军人的数据合并 截至2001年7月，护理系统。此数据将为我们提供有关药物依从性的详细结果， 糖基化的血红蛋白，血压，糖尿病并发症和死亡率。我们的研究人群将集中精力 在2001年7月之前诊断为糖尿病的退伍军人，以避免符合条件的退伍军人的潜在偏见 在政策变更后，患有沼泽的人可能会被激励被诊断出患有糖尿病。在我们的初选中 研究设计，我们建议比较沼泽 - NOG差异的时间趋势的变化 政策变更之前和之后（2001年和前几年与2002年及以后的几年）。