title: Race-ethnicity and gender differences in VA health care service utilization among U.S. veterans of recent conflicts.
abstract: OBJECTIVE
  The purpose of this study was to compare health care utilization patterns by race-ethnicity and gender among veterans returning from Iraq and Afghanistan.
  
  
  METHODS
  A retrospective analysis was conducted with records from U.S. service members and veterans returning from Iraq and Afghanistan who enrolled in health care through the Veterans Health Administration, who received a psychiatric diagnosis, and who had used primary or mental health outpatient care between October 7, 2001, and December 31, 2012 (N=309,050). Racial-ethnic minority groups were first collapsed together and compared with whites and then separated by racial-ethnic group. Gender was also tested as a moderator of utilization.
  
  
  RESULTS
  Although rates of mental health outpatient care, primary care, and emergency service utilization were relatively similar for racial-ethnic minority groups and whites, minority groups were admitted to psychiatric inpatient care at lower rates than whites. When veterans were separately categorized by specific racial-ethnic groups, some differences in utilization rates emerged; most notably, only black and Hispanic men were admitted less frequently to psychiatric inpatient care, and male and female Asian/Pacific Islander veterans used emergency services less, than their white counterparts. Gender moderated the association between race-ethnicity and mental health outpatient use, such that American Indian and Hispanic women used mental health outpatient services less than white women, but American Indian and Hispanic men showed the opposite pattern. Furthermore, black men were more likely than white men to use mental health outpatient services, but there was no difference between these women.
  
  
  CONCLUSIONS
  Although service utilization rates between minority groups and whites were similar when minority groups were combined, examination of utilization by racial-ethnic groups and by men and women separately yielded more robust findings.
authors.affiliation: The authors are with the Department of Mental Health, San Francisco Veterans Affairs Medical Center, San Francisco, California (e-mail: kelly.koo@va.gov ). Dr. Koo and Dr. Maguen are also with the Department of Psychiatry, University of California, San Francisco.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Koo
authors.forename: Erin
authors.initials: E
authors.lastname: Madden
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D001294:Attitude to Health; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult