Background: Improved access to care and quality of care can mitigate population level risk of heart disease and improve health outcomes. We sought to compare access to care in veterans versus non-veterans with cardiovascular disease (CVD) in the U.S.
Methods: The 2013 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 57,171 adults with CVD. Presence of CVD was noted with a single affirmative response to the following questions: “Has a health care professional ever told you that you had any of the following:” (1) a heart attack or myocardial infarction, (2) angina or coronary heart disease, (3) a stroke? Demographic data, clinical history and medication use were recorded in these patients. Access to care variables included report of financial barriers to medical care and/or prescription drug costs and report of delay in receiving medical care. Quality of care variables included annual blood cholesterol check, blood sugar testing, flu shot administration, antihypertensive use, and aspirin use.
Results: Among 57,171 adults with CVD studied, 13,205 (23.1%) were veterans while 43,966 (76.9%) were non-veterans. Veterans with CVD tended to be older (p<0.0001), male (95.6% vs 33.0%, p<0.0001), white (84.8% vs 76.6%, p<0.0001), married (57.3% vs 40.8%, p<0.0001), college-educated (60.9% vs 47.7%, p<0.0001), homeowners (81.1% vs 70.1%, p<0.0001), and with higher annual income. Veterans with CVD were more likely to be taking antihypertensive medications (93.3% vs 91.7%, p<0.0001) and have lower rates of current smoking (15.1% vs 18.9%, p<0.0001), chronic obstructive pulmonary disease (21.5% vs 23.1%, p=0.0003), asthma (12.7% vs 21.4%, p<0.0001), obesity (32.0% vs 36.9%, p<0.0001), physical inactivity (37.1% vs 44.3%, p<0.0001), and depressive disorders (22.0% vs 31.0%, p<0.0001). Veterans with CVD were less likely to report financial barriers to medical care (7.5% vs 15.6%, p<0.0001) and to medication costs (6.1% vs 14.7%, p<0.0001) and had higher rates of blood sugar testing (77.2% vs 72.2%, p<0.0001), blood cholesterol testing (98.2% vs 96.5%, p<0.0001), flu shot administration (64.2% vs 56.6%, p<0.0001), and annual check-up by a health care provider (88.7% vs 84.9%, p<0.0001). Veterans with CVD were more likely to be taking aspirin (77.1% vs 70.0%, p<0.0001). In multivariate analysis, being a veteran was associated with decreased odds of financial barriers to care (OR,0.82; 95% CI 0.73-0.92) and financial barriers to medication cost (OR,0.56; 95% CI 0.48-0.64). Compared to non-veterans, veterans had increased odds of medical checkup in past year (OR,1.25; 95% CI 1.13-1.38), cholesterol check in past year (OR, 1.21; 95% CI 1.07-1.37), and flu shot (OR,1.22; 95% CI 1.14-1.30).
Conclusion: Veterans with CVD receive improved access to care and quality of care compared to their non-veteran counterparts.