COVID-19 in VA Patients

Death Rates Compared with the General Population

This project compares COVID-19 mortality rate and deaths-per-case in the Veterans Affairs (VA) Health system with the general population (GP). We will explore both national and regional disparities to assess whether vetarans have been more vulnerable to COVID-19.

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Background

The US has close to 18 million veterans. That’s about 7% of the population. Veterans differ from the general population in several key ways that may increase their risk fo dying from COVID-19

Veterans are older. Their median age is 65, while the national median is 38. According to the CDC, the COVID-19 mortality rate for 65 year olds is 10 times that of a 38 year old.
More veterans live in rural areas, where hospitals may lack sufficient resources, personnel, or beds to provide critical care. Rural veterans must travel much father to reach a VA medical facility, which may discourage them from seeking COVID-19 tests or treatment.
Some of the comorbidities that increase risk of severe COVID-19 are more prevalent among veterans. While a few conditions are more common due to age, others may be linked to military service, such as exposure to environmental hazards.

Methods

The number of cases and deaths was collected from the VA COVID-19 dashboard and the New York Times GitHub repository. Information on demographics was found primarily from open-access government databases. The VA and GP data was statistically compared within each of the 18 Veterans Integrated Service Networks (VISNs) - large districts defined by the Veterans Health Administration. The data was further broken down into markets, subdivisions of VISNs, for regression analysis.

Key Finding #1

Veterans have a higher cumulative mortality rate than the GP overall. The degree of disparitiy is not uniform across regions.

In some regions, the VA patient mortality rate closely mirrors that of the GP. In many other areas, the VA mortality rate is higher (shown as darker on the map).

Key Finding #2

Daily deaths have decreased for both VA patients and the GP. However, the VA still had a higher mortality rate overall during period Jan.29 - Apr.28.

In many regions, the VA mortality rate was higher cumulatively but not in the last three months. This suggests that a greater share of the disproportionate deaths occured earlier in the pandemic.

VA patients have a significantly higher ratio of deaths per case (DPC).

DPC is the rate of death among patients who test positive for COVID-19. Mortality rate is among the whole population.

The difference in deaths per case remained after controlling for percent of the population 65+.

This suggests that other characteristics of VA patients are responsible for the higher DPC.

Living in more rural areas correlated significantly and positively with DPC for VA patients only.

VA patients living in rural areas may be more at risk. Rurality actually correlated negatively with DPC in the general population.

Key Finding #3

Linear regression models

indicate that...

Implications

This research suggests that COVID-19 deaths have occurred disproportionately in VA patients. The Veterans Health Administration should work to address the increased vulnerability of veterans and further investigate why this population faces a higher risk.