Carlson Kathleen F, Gilbert Tess A, O'Neil Maya E, Zaugg Tara L, Manning Candice A, Kaelin Christine, Thielman Emily J, Reavis Kelly M, Henry James A
VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR.
VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, OR.
Am J Audiol. 2019 Apr 22;28(1S):181-190. doi: 10.1044/2018_AJA-TTR17-18-0042.
Purpose Tinnitus is prevalent among military Veterans and may frequently co-occur with mental health disorders. This study examined health care utilization and mental health diagnoses among Veterans with and without tinnitus who receive Department of Veterans Affairs (VA) health care. Method We randomly sampled 10% of VA health care users for a 5-year period between 2011 and 2016. Tinnitus and other diagnoses were identified using International Classification of Diseases diagnosis codes; Veterans assigned 1 or more inpatient codes or 2 or more outpatient codes were considered to have the respective diagnosis. We examined demographics, military service, clinical characteristics, and health care utilization of Veterans with and without tinnitus diagnoses. Bivariable and multivariable logistic regression was used to estimate associations between tinnitus and mental health diagnoses of interest. Results Among 617,534 eligible Veterans, 3.8% met criteria for tinnitus diagnosis. Prevalence of tinnitus was associated with sex, age, race, marital status, and VA service connection status; additionally, hearing loss and traumatic brain injury were frequently codiagnosed with tinnitus. Veterans with tinnitus had higher annual health care utilization than those without. While controlling for potential confounders, tinnitus diagnoses were associated with mental health diagnoses, including anxiety, depression, and substance use disorders. Conclusion Findings suggest that Veterans who are diagnosed with tinnitus have more health care utilization and are more frequently diagnosed with mental health disorders than Veterans who are not diagnosed with tinnitus. This suggests a need for coordinated tinnitus and mental health care services for Veterans in the VA system of care.
耳鸣在退伍军人中很普遍,且可能经常与心理健康障碍同时出现。本研究调查了接受退伍军人事务部(VA)医疗保健的有耳鸣和无耳鸣退伍军人的医疗保健利用情况及心理健康诊断。方法:我们在2011年至2016年的5年期间,从VA医疗保健使用者中随机抽取了10%的样本。使用国际疾病分类诊断代码确定耳鸣及其他诊断;被分配1个或更多住院代码或2个或更多门诊代码的退伍军人被视为患有相应诊断。我们调查了有耳鸣诊断和无耳鸣诊断退伍军人的人口统计学、军事服役情况、临床特征及医疗保健利用情况。采用双变量和多变量逻辑回归来估计耳鸣与感兴趣的心理健康诊断之间的关联。结果:在617,534名符合条件的退伍军人中,3.8%符合耳鸣诊断标准。耳鸣患病率与性别、年龄、种族、婚姻状况及VA服役关联状态有关;此外,听力损失和创伤性脑损伤常与耳鸣同时被诊断出来。有耳鸣的退伍军人每年的医疗保健利用率高于无耳鸣的退伍军人。在控制潜在混杂因素的情况下,耳鸣诊断与心理健康诊断有关,包括焦虑、抑郁和物质使用障碍。结论:研究结果表明,与未被诊断出耳鸣的退伍军人相比,被诊断出耳鸣的退伍军人有更多的医疗保健利用,且更频繁地被诊断出患有心理健康障碍。这表明在VA医疗系统中,需要为退伍军人提供协调的耳鸣和心理健康护理服务。