Nietsch Katrina S, Estevez Samantha L, Goodsmith Nichole, Haeger Kristin O, Inderstrodt Jill, Inslicht Sabra S, Kosman Katherine A, Mu Qiyan, Nillni Yael I, Quinn Deirdre, Rodriguez Adriana, Siff Lauren, Stryczek Krysttel C, Tartaglione Erica V, Katon Jodie G
Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Health Equity. 2025 Apr 10;9(1):203-228. doi: 10.1089/heq.2024.0168. eCollection 2025.
Female veterans are the fastest growing group of new Veterans Health Administration (VA) users, and 40% identify as belonging to a racialized group. It is unclear if racial/ethnic disparities in reproductive health care and outcomes observed among nonveterans are present among veterans. The purpose of this scoping review was to characterize patterns of racial/ethnic disparities in reproductive health care and outcomes among female veterans.
A structured PubMed search was performed to extend a prior systematic review (from 2008-2017 to 2018-2023). We included original research on reproductive health care and outcomes in female veterans that also included a measure of association to race or ethnicity. Four hundred thirty-eight articles were identified for potential inclusion. Following PRISMA guidelines, titles and abstracts were screened in duplicate, and full articles were reviewed using a standardized abstraction form. Articles were sorted into six categories by topic (contraception, infertility, pregnancy, reproductive health screenings, gynecology, and menopause) and outcomes characterized as structural (e.g., organization of care), process (e.g., access to services), or clinical/behavioral (e.g., low birthweight) measures per Donabedian's model.
After title and abstract screening, 53 articles were reviewed in full. Four additional articles were excluded for a final sample of 49 articles. All articles described results from observational studies, which were almost exclusively focused on veterans using VA care (94%, = 46). Topics with the greatest number of articles included pregnancy (43%, = 21) and contraception (24%, = 12). Racial/ethnic disparities were detected more frequently for clinical and behavioral outcome measures than for process measures.
Consistent with literature regarding other types of VA care, racial/ethnic disparities were more prevalent for clinical and behavioral outcome measures versus process measures, highlighting that access is necessary but not sufficient for reaching health equity. Understanding the racial/ethnic health disparities and their relationships with different measures of health care quality is essential for achieving health equity for female veterans.
女性退伍军人是退伍军人健康管理局（VA）新用户中增长最快的群体，40%的人认定自己属于某个种族化群体。目前尚不清楚非退伍军人中观察到的生殖保健和结局方面的种族/族裔差异在退伍军人中是否存在。本范围综述的目的是描述女性退伍军人在生殖保健和结局方面的种族/族裔差异模式。
进行了结构化的PubMed搜索，以扩展先前的系统综述（从2008 - 2017年扩展到2018 - 2023年）。我们纳入了关于女性退伍军人生殖保健和结局的原始研究，这些研究还包括与种族或族裔的关联度量。共识别出438篇可能纳入的文章。按照PRISMA指南，对标题和摘要进行了双人筛选，并使用标准化的摘要表格对全文进行了审查。文章按主题分为六类（避孕、不孕、妊娠、生殖健康筛查、妇科和更年期），结局根据唐纳贝迪安模型分为结构（如护理组织）、过程（如获得服务的机会）或临床/行为（如低出生体重）指标。
在标题和摘要筛选后，对53篇文章进行了全文审查。另外排除了4篇文章，最终样本为49篇文章。所有文章都描述了观察性研究的结果，这些研究几乎都只关注使用VA护理的退伍军人（94%，n = 46）。文章数量最多的主题包括妊娠（43%，n = 21）和避孕（24%，n = 12）。临床和行为结局指标的种族/族裔差异比过程指标更频繁地被检测到。
与关于其他类型VA护理的文献一致，临床和行为结局指标的种族/族裔差异比过程指标更普遍，这突出表明获得服务是必要的，但对于实现健康公平并不充分。了解种族/族裔健康差异及其与不同医疗质量指标的关系对于实现女性退伍军人的健康公平至关重要。
