Regional variation in financial hardship among US veterans during the COVID-19 pandemic
Author:
Hauschildt Katrina E12ORCID, Bui David P3ORCID, Govier Diana J34ORCID, Eaton Tammy L156ORCID, Viglianti Elizabeth M17ORCID, Ettman Catherine K8ORCID, McCready Holly3, Smith Valerie A91011ORCID, O’Hare Ann M121314, Osborne Thomas F1516ORCID, Boyko Edward J17ORCID, Ioannou George N1218ORCID, Maciejewski Matthew L91011, Bohnert Amy S B119, Hynes Denise M32021ORCID, Iwashyna Theodore J12822ORCID, , Chai Wen, Bowling Barrett, Maciejewski Matthew, Womer James, Iwashyna Theodore, Anderson Stacy, Bernstein Taylor, Cabrales Aissa, Hauschildt Katrina, Admon Andrew, Byrd Kaitland, Cano Jennifer, Curtis Jeffrey, DelMonico Emily, Horowitz Dana, Kamphius Lee, Korpela Peggy, Kumbier Kyle, Langa Kenneth, Prescott Hallie, Rouse Marylena, Saini Sameer, Seelye Sarah, Sussman Jeremy, Wawrin Natalya, Monahan Max, Bohnert Amy, Viglianti Elizabeth, Akgun Kathleen, Aslan Mihaela, Cheung Kei-Hoi, Li Yuli, Mutalik Pradeep, Rajeevan Nallakkandi, Yan Lei, Anderson Livia, Berkowitz Theodore, Bogdan Joseph, Bosworth Hayden, Boucher Nathan, Cummin Graham, Dennis Paul, Floyd Breana, Hastings Susan Nicole, Kaufman Brystana, Meyer Cassie, Miles Amy, Naylor Jennifer, Shepherd-Banigan Megan, Smith Valerie, Smith Battista, Woods Christopher, Dobalian Aram, Goetz Matthew, Ikuta Kevin, Ong Michael, Shaukat Aasma, Backus Lisa, Ferguson Jacqueline, Osborne Thomas, Shahoumian Troy, Veigulis Zachary, Zulman Donna, Bajema Kristina, Bui David, Chen Jason, Govier Diana, Helfand Mark, Hickok Alex, Hough Catherine, McCready Holly, Moss Abby, Newell Summer, Niederhausen Meike, Nugent Shannon, Saha Somnath, Slatore Christopher, Takata Yumie, Teo Alan, Tuepker Anais, Vranas Kelly, Winchell Kara, Hynes Denise, Boyko Edward, Au David, Baraff Aaron, Berry Wyatt Kristin, Borgerding Joleen, Burwick Nicholas, Crothers Kristina, Davis Marie, Doll Jacob, Dominitz Jason, Eastment McKenna, Fan Vincent, Fox Alexandra, Hawkins Eric, Hebert Paul, Hu Elaine, Korpak Anna, Morelli Daniel, Peterson Alexander, Reddy Ashok, Shah Javeed, Showalter Whitney, Smith Nicholas, Suri Pradeep, Thomas Eva, Turner Aaron, Vig Elizabeth, Wicks Katrina, Wong Edwin, Wysham Katherine, Ioannou George, O'Hare Ann, Jones Barbara, Jones Makoto, Knight Sara
Affiliation:
1. VA Center for Clinical Management Research, Ann Arbor VA , Ann Arbor, MI 48109 , United States 2. Department of Medicine, School of Medicine, Johns Hopkins University , Baltimore, MD 21205 , United States 3. Center to Improve Veteran Involvement in Care, VA Portland Health Care System , Portland, OR 97239 , United States 4. Oregon Health & Science University—Portland State University School of Public Health , Portland, OR 97201 , United States 5. University of Michigan Institute for Healthcare Policy & Innovation , Ann Arbor, MI 48109 , United States 6. Division of Hospital Medicine, Department of Internal Medicine, University of Michigan , Ann Arbor, MI 48109 , United States 7. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan , Ann Arbor, MI 48109 , United States 8. School of Public Health, Johns Hopkins University , Baltimore, MD 21205 , United States 9. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System , Durham, NC 27705 , United States 10. Department of Medicine, Duke University , Durham, NC 27710 , United States 11. Department of Population Health Sciences, Duke University School of Medicine , Durham, NC 27710 , United States 12. Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Healthcare System , Seattle, WA 98108 , United States 13. Hospital and Specialty Medicine Service, Veterans Affairs Puget Sound Health Care System , Seattle, WA 98108 , United States 14. Department of Medicine, University of Washington , Seattle, WA 98195 , United States 15. VA Palo Alto Healthcare System , Palo Alto, CA 94304 , United States 16. Department of Radiology, Stanford University School of Medicine , Stanford, CA 94305 , United States 17. Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System , Seattle, WA 98108 , United States 18. Division of Gastroenterology, Department of Medicine, University of Washington , Seattle, WA 98195 , United States 19. Department of Anesthesiology, University of Michigan Medical School , Ann Arbor, MI 48109 , United States 20. College of Health, and Center for Quantitative Life Sciences, Oregon State University , Corvallis, OR 97331 , United States 21. School of Nursing, Oregon Health and Science University , Portland, OR 97201 , United States 22. Department of Medicine, University of Michigan Medical School , Ann Arbor, MI 48109 , United States
Abstract
Abstract
Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)–enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform. Regional variation in veteran financial hardship demonstrates a need for further research about the role and interaction of federal and state financial-assistance policies in shaping risks for financial hardship as well as potential opportunities to mitigate risks among veterans and reduce variation across regions.
Funder
VA Health Services Research
Publisher
Oxford University Press (OUP)
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