title: Health care utilization and receipt of cholesterol testing by veterans with and those without mental illness.
abstract: 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.
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, USA. rebekah.kaplowitz@med.va.gov
authors.forename: Rebekah A
authors.initials: RA
authors.lastname: Kaplowitz
authors.forename: Richard E
authors.initials: RE
authors.lastname: Scranton
authors.forename: David R
authors.initials: DR
authors.lastname: Gagnon
authors.forename: Colleen
authors.initials: C
authors.lastname: Cantillon
authors.forename: James W
authors.initials: JW
authors.lastname: Levenson
authors.forename: Howard D
authors.initials: HD
authors.lastname: Sesso
authors.forename: Louis D
authors.initials: LD
authors.lastname: Fiore
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
mesh_terms: 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
chemical_list: D002784:Cholesterol