title: Comparison of outpatient health care utilization among returning women and men veterans from Afghanistan and Iraq.
abstract: BACKGROUND
  The number of women serving in the United States military increased during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), leading to a subsequent surge in new women Veterans seeking health care services from the Veterans Administration (VA). The objective of this study was to examine gender differences among OEF/OIF Veterans in utilization of VA outpatient health care services.
  
  
  METHODS
  Our retrospective cohort consisted of 1,620 OEF/OIF Veterans (240 women and 1380 men) who enrolled for outpatient healthcare at a single VA facility. We collected demographic data and information on military service and VA utilization from VA electronic medical records. To assess gender differences we used two models: use versus nonuse of services (logistic regression) and intensity of use among users (negative binomial regression).
  
  
  RESULTS
  In our sample, women were more likely to be younger, single, and non-white than men. Women were more likely to utilize outpatient care services (odds ratio [OR] = 1.47, 95% confidence interval [CI]:1.09, 1.98), but once care was initiated, frequency of visits over time (intensity) did not differ by gender (incident rate ratio [IRR] = 1.07; 95% CI: 0.90, 1.27).
  
  
  CONCLUSIONS
  Recently discharged OEF/OIF women Veterans were more likely to seek VA health care than men Veterans. But the intensity of use was similar between women and men VA care users. As more women use VA health care, prospective studies exploring gender differences in types of services utilized, health outcomes, and factors associated with satisfaction will be required.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. mona.duggal@yale.edu
authors.forename: Mona
authors.initials: M
authors.lastname: Duggal
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Julie
authors.initials: J
authors.lastname: Womack
authors.forename: Kirsha
authors.initials: K
authors.lastname: Gordon
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Brandt
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D012189:Retrospective Studies; D014481:United States; D014728:Veterans