BACKGROUND: Chronic diseases continue to be among the leading causes of mortality in Texas. Veterans receive greater access to healthcare through the U.S. Department of Veteran Affairs system, which may reduce their chronic disease burden in comparison to their civilian counterparts. The purpose of this study was to examine chronic disease diagnoses among the veteran population in comparison to civilians in Texas.
METHODS: Data from the 2014 Texas Behavioral Risk Factor Surveillance System (BRFSS) was analyzed. Veteran status was the primary predictor variable, characterized by ever having served in the U.S. Armed forces (yes/no). Six self-reported doctor-diagnosed chronic conditions were individually assessed as outcomes: heart disease, cancer, chronic lower respiratory disease (CLRD), stroke, diabetes, and kidney disease. Logistic regression models were used to determine the odds of chronic disease diagnosis among veterans compared to civilians. The models were adjusted for demographic characteristics (sex, age, race/ethnicity, education) and risk behaviors (obesity, binge drinking, cigarette use). Descriptive statistics were calculated using Chi-square tests (using p<0.05). All analyses were performed using SAS 9.4.
RESULTS: In 2014, 11.0% of the Texas adult population were U.S. veterans. Compared to their civilian counterparts, veterans were significantly more likely to be white (64.5% vs. 44.2%), male (88.1% vs. 44.4%), have obtained some college education (40.2% vs. 29.9%), and aged 65 and older (35.3% vs. 13.6%). The odds of being diagnosed with heart disease (adjusted OR (aOR): 1.70, 95% Confidence Interval (CI): 1.26-2.30) and cancer (aOR: 1.45, 95% CI: 1.15-1.81) were significantly higher among veterans compared to civilians in the fully adjusted model. The unadjusted odds of being diagnosed with diabetes (OR: 1.75, 95% CI: 1.44-2.13), stroke (OR: 2.24, 95% CI: 1.53-3.28) and kidney disease (OR: 1.74, 95% CI: 1.14-2.66;) were higher among veterans but the association was no longer significant after adjustment (aOR: 1.25, 95% CI: 0.95-1.64; aOR: 1.31, 95% CI: 0.82-2.12; aOR: 1.33, 95% CI: 0.84-2.09; respectively). There was no difference in the odds of being diagnosed with CLRD among veterans compared to civilians.
CONCLUSIONS: In Texas, veterans were more likely than civilians to be diagnosed with heart disease and cancer. Demographic characteristics and risk behaviors accounted for much of the association between chronic disease diagnosis and veteran status. This information can be used to help inform public health intervention activities. Additional research is needed to understand the role of comorbidities on chronic disease diagnosis among veterans.