Journal of General Internal Medicine

, Volume 22, Issue 9, pp 1260–1267

Effect of Health-Related Quality of Life on Women and Men’s Veterans Affairs (VA) Health Care Utilization and Mortality

Original Article



Although women will account for almost 11% of veterans by 2040, we know little about their health and functioning, particularly compared to men.


To compare women and men veterans’ health-related quality of life (HRQOL) and VA health care utilization and to see if previously described associations between HRQOL, subsequent VA health care utilization, and mortality in male veterans would generalize to women veterans.


Prospective cohort study of all veterans who received medical care from an Upper Midwest Veterans Affairs facility between 10/1/96 and 3/31/98 and returned a mailed questionnaire.


Women’s effective survey response rate was 52% (n = 1,500); men’s, 58% (n = 35,000). In the following year, 9% of women and 12% of men had at least one hospitalization. One percent of women and 3% of men died in the post-survey year. After adjustment, women’s HRQOL was higher than men’s; for every 10-point decrement in overall physical or mental functioning, women and men had similarly increased risk/odds of subsequently dying, being hospitalized at a VA facility, or making a VA outpatient stop. Among younger women and women who received VA care outside of the Twin City metro area, poorer overall mental or physical health functioning was associated with fewer primary care stops; among their male counterparts, it was associated with more primary care stops.


Compared to men, women veterans receiving VA health care in the upper Midwest catchment area had better HRQOL and used fewer health services. Although VA health care utilization was similar across gender after adjusting for HRQOL, poorer mental or physical health was associated with fewer primary care stops for selected subgroups of women.


gender quality of life health care utilization veterans 


  1. 1.
    Perlin JB, Kolodner RM, Roswell RH. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Manag Care. 2004 Nov;10(11 Pt 2):828–36.PubMedGoogle Scholar
  2. 2.
    Iglehart JK. Reform of the veterans affairs heath care system. N Engl J Med. 1996 Oct 31;335(18):1407–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med. 2000 Nov 27;160(21):3252–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Kazis LE, Miller DR, Clark J, Skinner K, Lee A, Rogers W, et al. Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. Arch Intern Med. 1998 Mar 23;158(6):626–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Oddone EZ, Petersen LA, Weinberger M, Freedman J, Kressin NR. Contribution of the Veterans Health Administration in understanding racial disparities in access and utilization of health care: a spirit of inquiry. Med Care. 2002 Jan;40(1 suppl):I3–13.PubMedGoogle Scholar
  6. 6.
    Wilson NJ, Kizer KW. The VA health care system: an unrecognized national safety net. Health Aff (Millwood). 1997 Jul–Aug;16(4):200–4.CrossRefGoogle Scholar
  7. 7.
    Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004 Dec 21;141(12):938–45.PubMedGoogle Scholar
  8. 8.
    Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med. 2003 May 29;348(22):2218–27.PubMedCrossRefGoogle Scholar
  9. 9.
    Kerr EA, Gerzoff RB, Krein SL, et al. Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: the TRIAD study. Ann Intern Med. 2004 Aug 17;141(4):272–81.PubMedGoogle Scholar
  10. 10.
    Richardson, C., Waldrop, J. Veterans: 2000. Census 2000 Brief. 2003 [cited; Available from:
  11. 11.
    VA Health care for Women: Progress made in Providing Services for Women Veterans. Washington, DC: US General Accounting Office; 1992. Report No.: GAO/HEIS-99-38.Google Scholar
  12. 12.
    Frayne SM, Parker VA, Christiansen CL, et al. Health status among 28,000 women veterans. The VA Women’s Health Program Evaluation Project. J Gen Intern Med. 2006 Mar;21(suppl 3):S40–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Skinner K, Sullivan LM, Tripp TJ, et al. Comparing the health status of male and female veterans who use VA health care: results from the VA Women’s Health Project. Women Health. 1999;29(4):17–33.PubMedCrossRefGoogle Scholar
  14. 14.
    US General Accounting Office. VA health care for women: despite progress, improvements needed January 1992 (GAO-HRD-92-92).Google Scholar
  15. 15.
    Yano EM, Bastian LA, Frayne SM, et al. Toward a VA Women’s Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans. J Gen Intern Med. 2006 Mar;21(suppl 3):S93–101.PubMedCrossRefGoogle Scholar
  16. 16.
    Hoff RA, Rosenheck RA. Female veterans’ use of Department of Veterans Affairs health care services. Med Care. 1998 Jul;36(7):1114–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Wolinsky FD, Coe RM, Mosely RR, 2nd, Homan SM. Veterans’ and nonveterans’ use of health services. A comparative analysis. Med Care. 1985 Dec;23(12):1358–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Singh JA, Borowsky SJ, Nugent S, et al. Health-related quality of life, functional impairment, and healthcare utilization by veterans: veterans’ quality of life study. J Am Geriatr Soc. 2005 Jan;53(1):108–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Kazis L, Skinner K, Rogers W, et al. Health status of veterans: physical and mental component summary scores (SF-36V). 1998 National Survey of Ambulatory Care Patients. Executive Report: Department of Veterans Affairs, Veterans Health Administration, Office of Performance and Quality, Washington D.C.Google Scholar
  20. 20.
    Ware JE, Jr., Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995 Apr;33(4 suppl):AS264–79.PubMedGoogle Scholar
  21. 21.
    Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Ware JE, Jr. SF-36 Health Survey Manual and Interpretation Guide. Boston: The Health Institute, New England Medical Center; 1993.Google Scholar
  23. 23.
    Kosloski K, Austin C, Borgatta E. Determinants of VA utilization. The 1983 survey of aging veterans. Med Care. 1987 Sep;25(9):830–46.PubMedCrossRefGoogle Scholar
  24. 24.
    Rosenheck R, Massari L. Wartime military service and utilization of VA health care services. Mil Med. 1993 Apr;158(4):223–8.PubMedGoogle Scholar
  25. 25.
    Hopman WM, Towheed T, Anastassiades T, et al. Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group. CMAJ. 2000 Aug 8;163(3):265–71.PubMedGoogle Scholar
  26. 26.
    Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health. 1999 Jan;53(1):46–50.PubMedCrossRefGoogle Scholar
  27. 27.
    Samsa G, Edelman D, Rothman ML, Williams GR, Lipscomb J, Matchar D. Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics. 1999 Feb;15(2):141–55.PubMedCrossRefGoogle Scholar
  28. 28.
    Louis Harris and Associates: Survey of Female Veterans: A study of the needs, attitudes, and experiences of women veterans (1985). Washington, DC: Veterans Administration.Google Scholar
  29. 29.
    Dalager NA, Kang HK, Thomas TL. Cancer mortality patterns among women who served in the military: the Vietnam experience. J Occup Environ Med. 1995 Mar;37(3):298–305.PubMedCrossRefGoogle Scholar
  30. 30.
    Kang HK, Bullman TA. Mortality among U.S. veterans of the Persian Gulf War. N Engl J Med. 1996 Nov 14;335(20):1498–504.PubMedCrossRefGoogle Scholar
  31. 31.
    Thomas TL, Kang HK, Dalager NA. Mortality among women Vietnam veterans, 1973–1987. Am J Epidemiol. 1991 Nov 1;134(9):973–80.PubMedGoogle Scholar
  32. 32.
    Cope JR, Yano EM, Lee ML, Washington DL. Determinants of contraceptive availability at medical facilities in the Department of Veterans Affairs. J Gen Intern Med. 2006 Mar;21(suppl 3):S33–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Burgess JF, Jr., DeFiore DA. The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services. Soc Sci Med. 1994 Jul;39(1):95–104.CrossRefGoogle Scholar
  34. 34.
    Druss BG, Rosenheck RA. Use of medical services by veterans with mental disorders. Psychosomatics. 1997 Sep–Oct;38(5):451–8.PubMedGoogle Scholar
  35. 35.
    Gamache G, Rosenheck RA, Tessler R. Factors predicting choice of provider among homeless veterans with mental illness. Psychiatr Serv. 2000 Aug;51(8):1024–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Gilbert GH, Branch LG, Longmate J. Eligible veterans’ choice between VA-covered and non-VA-covered dental care. J Public Health Dent. 1992 Fall;52(5):277–87.PubMedCrossRefGoogle Scholar
  37. 37.
    Rosenheck R, Stolar M. Access to public mental health services: determinants of population coverage. Med Care. 1998 Apr;36(4):503–12.PubMedCrossRefGoogle Scholar
  38. 38.
    Uchino B. Social Support and Physical Health: Understanding the Health Consequences of Relationships New Haven: Yale University Press; 2004.Google Scholar
  39. 39.
    Klein R. Women Veterans: Past, Present and Future. Revised and Updated: U.S. Department of Veterans Affairs; May 2005.Google Scholar
  40. 40.
    Stern A, Wolfe J, Daley J, Zaslavsky A, Roper SF, Wilson K. Changing demographic characteristics of women veterans: results from a national sample. Mil Med. 2000 Oct;165(10):773–80.PubMedGoogle Scholar
  41. 41.
    Vogt DS, Stone ER, Salgado DM, King LA, King DW, Savarese VW. Gender awareness among Veterans Administration health-care workers: existing strengths and areas for improvement. Women Health. 2001;34(4):65–83.PubMedCrossRefGoogle Scholar
  42. 42.
    Ouimette P, Wolfe J, Daley J, Gima K. Use of VA health care services by women veterans: findings from a national sample. Women Health. 2003;38(2):77–91.PubMedCrossRefGoogle Scholar
  43. 43.
    Clancy CM, Massion CT. American women’s health care. A patchwork quilt with gaps. JAMA. 1992 Oct 14;268(14):1918–20.PubMedCrossRefGoogle Scholar
  44. 44.
    Rosenheck R. Primary care satellite clinics and improved access to general and mental health services. Health Serv Res. 2000 Oct;35(4):777–90.PubMedGoogle Scholar
  45. 45.
    Borowsky SJ, Nelson DB, Nugent SM, et al. Characteristics of veterans using Veterans Affairs community-based outpatient clinics. J Health Care Poor Underserved. 2002 Aug;13(3):334–46.PubMedCrossRefGoogle Scholar
  46. 46.
    Cradock-O’Leary J, Young AS, Yano EM, Wang M, Lee ML. Use of general medical services by VA patients with psychiatric disorders. Psychiatr Serv. 2002 Jul;53(7):874–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Dickerson FB, Pater A, Origoni AE. Health behaviors and health status of older women with schizophrenia. Psychiatr Serv. 2002 Jul;53(7):882–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Salsberry PJ, Chipps E, Kennedy C. Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatr Serv. 2005 Apr;56(4):458–62.PubMedCrossRefGoogle Scholar
  49. 49.
    Berren MR, Santiago JM, Zent MR, Carbone CP. Health care utilization by persons with severe and persistent mental illness. Psychiatr Serv. 1999 Apr;50(4):559–61.PubMedGoogle Scholar
  50. 50.
    National Center for Veteran Analysis and Statistics. National Survey of Veterans. Vol April. Washington, DC: Government Printing Office: 1995.Google Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  1. 1.Rheumatology SectionMinneapolis VA Medical CenterMinneapolisUSA
  2. 2.Medicine ServiceMinneapolis VA Medical CenterMinneapolisUSA
  3. 3.Division of RheumatologyUniversity of MinnesotaMinneapolisUSA
  4. 4.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  5. 5.Center for Epidemiological and Clinical Research (CECR)VA Medical CenterMinneapolisUSA
  6. 6.Center for Chronic Disease Outcomes Research (CCDOR)VA Medical CenterMinneapolisUSA
  7. 7.Rheumatology Division (111 R)Minneapolis VA Medical CenterMinneapolisUSA
  8. 8.Visiting ScientistMayo Clinic School of MedicineRochesterUSA

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