Center of Innovation in Long-term Services and Supports for Vulnerable Veterans, Providence VA Medical Center, Providence, Rhode Island.
Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island.
JAMA Intern Med. 2022 Jul 1;182(7):757-765. doi: 10.1001/jamainternmed.2022.2159.
It remains poorly understood whether income assistance for adults with low income and disability improves health outcomes.
To examine the association between eligibility for disability compensation and mortality and hospitalizations among Vietnam-era veterans with diabetes.
DESIGN, SETTING, AND PARTICIPANTS: Quasiexperimental cohort study of a July 1, 2001, policy that expanded eligibility for disability compensation to veterans with "boots on the ground" (BOG) during the Vietnam era on the basis of a diagnosis of diabetes; veterans who were "not on ground" (NOG) remained ineligible. Participants were Vietnam-era veterans with diabetes in the Veterans Affairs Healthcare System. Difference-in-differences were estimated during early (July 1, 2001-December 31, 2007), middle (January 1, 2008-December 31, 2012), and later (January 1, 2013-December 31, 2018) postpolicy periods. Data analysis was performed from October 1, 2020, to December 1, 2021.
Interaction between having served with BOG (as recorded in Vietnam-era deployment records) and postpolicy period.
Primary outcomes were all-cause mortality and hospitalizations.
The study population included 14 247 BOG veterans (mean [SD] age at baseline, 51.2 [3.8] years; 25.7% were Black; 3.3% were Hispanic; 63.6% were White; and 6.9% were of other race) and 56 224 NOG veterans (mean [SD] age, 54.2 [6.3] years; 21.7% were Black; 2.1% were Hispanic; 67.1% were White; and 8.2% were of other race). Compared with NOG veterans, BOG veterans received $8025, $14412, and $17 162 more in annual disability compensation during the early, middle, and later postpolicy periods, respectively. Annual mortality rates were unchanged (prepolicy mortality rates: 3.04% for BOG and 3.56% for NOG veterans), with adjusted difference-in-differences of 0.24 percentage points (95% CI, -0.08 to 0.52), -0.08% (95% CI, -0.40 to 0.24), and -0.08% (95% CI, -0.48 to 0.36), during the early, middle, and later postpolicy periods. Among 3623 BOG veterans and 19 174 NOG veterans with Medicare coverage in 1999, a population whose utilization could be completely observed in our data, BOG veterans experienced reductions of -7.52 hospitalizations per 100 person-years (95% CI, -13.12 to -1.92) during the early, -10.12 (95% CI, -17.28 to -3.00) in the middle, and -15.88 (95% CI, -24.00 to -7.76) in the later periods. These estimates represent relative declines of 10%, 13%, and 21%. Falsification tests of BOG and NOG veterans who were already receiving maximal disability compensation prior to the policy yielded null findings.
In this cohort study, disability compensation among Vietnam-era veterans with diabetes was not associated with lower mortality but was associated with substantial declines in acute hospitalizations. Veterans' disability compensation payments may have important health benefits.
重要性：目前尚不清楚为低收入和残疾的成年人提供收入援助是否能改善健康结果。
目的：研究越南时代糖尿病退伍军人的残疾补偿资格与死亡率和住院率之间的关联。
设计、地点和参与者：这是一项准实验队列研究，研究对象为 2001 年 7 月 1 日一项政策的退伍军人，该政策扩大了“在越南时代有实地作战经历”（BOG）的退伍军人获得残疾补偿的资格，前提是他们被诊断患有糖尿病；“没有实地作战经历”（NOG）的退伍军人仍然没有资格获得残疾补偿。参与者是退伍军人医疗保健系统中患有糖尿病的越南时代退伍军人。在政策实施的早期（2001 年 7 月 1 日至 2007 年 12 月 31 日）、中期（2008 年 1 月 1 日至 2012 年 12 月 31 日）和后期（2013 年 1 月 1 日至 2018 年 12 月 31 日），估计了差异中的差异。数据分析于 2020 年 10 月 1 日至 2021 年 12 月 1 日进行。
暴露情况：有 BOG 服役经历（记录在越南时代的部署记录中）与政策实施后的时期之间的相互作用。
主要结果和措施：主要结果是全因死亡率和住院率。
结果：研究人群包括 14247 名 BOG 退伍军人（基线时的平均[SD]年龄为 51.2[3.8]岁；25.7%为黑人；3.3%为西班牙裔；63.6%为白人；6.9%为其他种族）和 56224 名 NOG 退伍军人（平均[SD]年龄为 54.2[6.3]岁；21.7%为黑人；2.1%为西班牙裔；67.1%为白人；8.2%为其他种族）。与 NOG 退伍军人相比，BOG 退伍军人在政策实施的早期、中期和后期分别获得了 8025 美元、14412 美元和 17162 美元的额外年度残疾补偿。年度死亡率保持不变（政策前死亡率：BOG 退伍军人为 3.04%，NOG 退伍军人为 3.56%），调整后的差异中的差异为 0.24 个百分点（95%CI，-0.08 至 0.52），-0.08%（95%CI，-0.40 至 0.24）和-0.08%（95%CI，-0.48 至 0.36），分别在政策实施的早期、中期和后期。在有 Medicare 保险的 3623 名 BOG 退伍军人和 19174 名 NOG 退伍军人中，这部分人群的利用情况可以在我们的数据中完全观察到，BOG 退伍军人的住院率减少了 7.52 人/100 人年（95%CI，-13.12 至-1.92），在中期减少了 10.12 人/100 人年（95%CI，-17.28 至-3.00），在后期减少了 15.88 人/100 人年（95%CI，-24.00 至-7.76）。这些估计值代表 10%、13%和 21%的相对下降。对政策实施前已经获得最大残疾补偿的 BOG 和 NOG 退伍军人进行的验证性检验没有发现无效结果。
结论：在这项队列研究中，越南时代糖尿病退伍军人的残疾补偿与死亡率降低无关，但与急性住院率的大幅下降有关。退伍军人的残疾补偿支付可能对健康有重要益处。
