title: Gender differences in health care utilization among veterans with chronic pain.
abstract: BACKGROUND
  Previous research reports that 48% of veterans regularly experience and express concern over pain. Outpatient service use is higher for veterans with pain than for veterans without pain. Our study objective was to identify differences in outpatient utilization between men and women veterans with chronic pain.
  
  
  METHODS
  We identified all men and women veterans at the Durham Veterans Affairs Medical Center in fiscal year (FY) 2002 between the ages of 21 and 60 that had two visits for the same pain location at least 6 weeks apart as determined by ICD-9 coding. Men and women were age-matched at a 2:1 ratio. We then compared the number of outpatient visits between genders in FY 2003.
  
  
  RESULTS
  We identified 406 female and 812 male veterans. The mean number of clinic visits for women was 25.2 (SD 30.2) and for men 17.6 (SD 24.1). After adjusting for multiple pain sites, psychiatric diagnoses, age, and comorbidities, women veterans had a 27% higher rate of outpatient visits than men (incidence rate ratio [RR] 1.27, 95% confidence [CI] 1.15 to 1.41). Specifically, women had higher rates of visits to primary care (RR 1.36, 95% CI 1.24 to 1.50), physical therapy (RR 1.67, 95% CI 1.20 to 2.33), and other clinics (RR 1.28, 95% CI 1.14 to 1.44), and had a higher rate of visits to address pain (RR 1.15, 95% CI 1.02 to 1.30) than men.
  
  
  CONCLUSIONS
  This is the first study to examine gender differences in chronic pain and utilization in the veteran population. Women veterans with chronic pain may need more resources to adequately manage chronic pain conditions as well as associated comorbidities and psychiatric disease.
authors.affiliation: Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA. suneet.kaur@duke.edu
authors.forename: Suneet
authors.initials: S
authors.lastname: Kaur
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stechuchak
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Allen
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D059408:Pain Management; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012727:Sex Characteristics; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans