Centers for American Indian and Alaskan Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
U.S. Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, UT, USA.
J Racial Ethn Health Disparities. 2020 Dec;7(6):1071-1078. doi: 10.1007/s40615-020-00730-w. Epub 2020 Mar 18.
The health service ecology varies considerably across urban-rural divides for American Indian and Alaska Native (AIAN) veterans, which may place rural AIAN veterans at high risk for poor health outcomes. Using the Behavioral Risk Factor Surveillance System 2011 and 2012 data for its detailed race information, we employed adjusted multinomial logistical regression analyses to estimate differences in health outcomes among rural AIAN veterans (n = 1500) and urban AIAN veterans (n = 1567). We used rural White (n = 32,316) and urban White (n = 59,849) veteran samples as comparators. No statistically significant differences between urban and rural AIAN veterans' health outcomes were found. Urban AIAN veterans were 72% more likely to report financial barriers to care compared with urban White veterans (P = .002); no other healthcare access differences were found. Compared with their White veteran counterparts, both urban and rural AIAN veterans were significantly more likely to report poorer physical and mental health across an array of outcomes. Overall, rural and urban AIAN veterans' health outcomes were similar, but both groups suffered compromised health compared with that of both rural and urban White veterans. The findings identified key areas for improving and innovating care for both rural and urban AIAN veterans.
美国印第安人和阿拉斯加原住民（AIAN）退伍军人的医疗服务生态在城乡之间存在显著差异，这可能使农村 AIAN 退伍军人面临健康状况不佳的高风险。利用 2011 年和 2012 年行为风险因素监测系统的数据，我们采用调整后的多项逻辑回归分析来估计农村 AIAN 退伍军人（n=1500）和城市 AIAN 退伍军人（n=1567）之间健康结果的差异。我们使用农村白人（n=32316）和城市白人（n=59849）退伍军人样本作为对照。城乡 AIAN 退伍军人的健康结果之间没有发现统计学上的显著差异。与城市白人退伍军人相比，城市 AIAN 退伍军人报告医疗保健方面存在经济障碍的可能性高 72%（P=0.002）；没有发现其他医疗保健获得方面的差异。与他们的白人退伍军人相比，城市和农村 AIAN 退伍军人在一系列结果中更有可能报告身体和心理健康状况较差。总体而言，城乡 AIAN 退伍军人的健康结果相似，但与农村和城市白人退伍军人相比，这两个群体的健康状况都受到了影响。这些发现确定了改善和创新城乡 AIAN 退伍军人医疗服务的关键领域。
