Health care utilization and receipt of cholesterol testing by veterans with and those without mental illness.
OBJECTIVE
We examined the relationship between mental illness, health care utilization and rates of cholesterol testing.


METHODS
We conducted a retrospective cohort study using Veterans Affairs (VA) administrative data on 64,490 United States veterans who used VA New England Health Care System outpatient services between January 1998 and June 2001. A total of 10,100 veterans (15.7%) had a mental illness treated with medication. We examined the interaction between mental illness and outpatient service utilization with respect to the likelihood of receiving a cholesterol test, adjusting for major demographic and clinical covariates.


RESULTS
Among veterans using VA outpatient services infrequently, those with mental illness were less likely than non-mentally ill control subjects to receive a cholesterol test during the study period (first quartile adjusted OR=0.45, 95% CI=0.37-0.54; second quartile adjusted OR=0.50, 95% CI=0.45-0.57). Mentally ill subjects with more frequent utilization of VA services were as likely as (third quartile adjusted OR=1.01, 95% CI=0.91-1.13) or more likely than (fourth quartile adjusted OR=2.73, 95% CI=2.46-3.03) non-mentally ill subjects to receive cholesterol testing.


CONCLUSIONS
Mental illness was associated with a lower likelihood of cholesterol testing in subjects who used fewer VA outpatient services. The observed disparity attenuated at higher levels of service utilization.
Kaplowitz
Rebekah A
RA
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, USA. rebekah.kaplowitz@med.va.gov
Scranton
Richard E
RE
Gagnon
David R
DR
Cantillon
Colleen
C
Levenson
James W
JW
Sesso
Howard D
HD
Fiore
Louis D
LD
Gaziano
J Michael
JM
D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000032:analysis* / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000175:diagnosis*; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D014728:Veterans
D002784:Cholesterol