title: Racial Differences in Chronic Conditions and Sociodemographic Characteristics Among High-Utilizing Veterans.
abstract: OBJECTIVE
  African-Americans are disproportionally represented among high-risk, high-utilizing patients. To inform program development for this vulnerable population, the current study describes racial variation in chronic conditions and sociodemographic characteristics among high-utilizing patients in the Veterans Affairs Healthcare System (VA).
  
  
  METHODS
  We identified the 5 % most costly Veterans who used inpatient or outpatient care at the VA during fiscal year 2010 (N = 237,691) based on costs of inpatient and outpatient care, pharmacy services, and VA-sponsored contract care. Patient costs and characteristics were abstracted from VA outpatient and inpatient data files. Racial differences in sociodemographic characteristics (age, sex, marital support, homelessness, and health insurance status) were assessed with chi-square tests. Racial differences in 32 chronic condition diagnoses were calculated as relative risk ratios.
  
  
  RESULTS
  African-Americans represented 21 % of high-utilizing Veterans. African-Americans had higher rates of homelessness (26 vs. 10 %, p < 0.001) and lower rates of supplemental health insurance (44 vs. 58 %, p < 0.001). The mean number of chronic conditions was similar across race. However, there were racial differences in the prevalence of specific chronic conditions, including a higher prevalence of HIV/AIDS (95 % confidence interval (CI) 4.86, 5.50) and schizophrenia (95 % CI 1.94, 2.07) and a lower prevalence of ischemic heart disease (95 % CI 0.57, 0.59) and bipolar disorder (95 % CI 0.78, 0.85) among African-American high-utilizing Veterans.
  
  
  CONCLUSIONS
  Racial disparities among high-utilizing Veterans may differ from those found in the general population. Interventions should devote attention to social, environmental, and mental health issues in order to reduce racial disparities in this vulnerable population.
authors: Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA. breland@stanford.edu.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94304, USA. breland@stanford.edu.
authors: Jessica Y
authors: JY
authors: Breland
authors: Department of Veterans Affairs, Health Economics Resource Center, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.|Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, 616 Serra Street, Stanford, CA, 94305, USA.
authors: Christine Pal
authors: CP
authors: Chee
authors: Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.|Division of General Medical Disciplines, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94304, USA.
authors: Donna M
authors: DM
authors: Zulman
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000208:ethnology*; D005260:Female; D054624:Health Status Disparities; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017533:Marital Status / Q000208:ethnology; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: African-American; Chronic conditions; High-utilizing patients; Racial disparities; Veterans