Inequities in weathering California wildfires.

Two separate wildfires in different Los Angeles communities illustrate the disparate effects of and recovery from wildfires. Our comparison of patient and community characteristics of Veterans living in the affected areas related to social vulnerability identified specific vulnerabilities, and can inform policy levers to support more equitable disaster response and recovery efforts.

Enhancing Vocational Rehabilitation Services for Homeless-Experienced Veterans in Permanent Supportive Housing.

Few homeless-experienced individuals use vocational rehabilitation services. Using qualitative methods, as part of a pilot study at VA Greater Los Angeles (GLA), we characterized the perspectives of homeless-experienced persons and homeless program staff on vocational services. We also explored relationships among employment, housing, and well-being in this group.

Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans.

Background: Hypertension control and related cardiovascular outcomes among Americans remain suboptimal, and differ by race, ethnicity, and geography. Healthcare access is one of multiple critical factors in hypertension control. Understanding the degree to which healthcare access, versus other factors, produce these outcomes can inform policies and interventions to improve cardiovascular outcomes and reduce disparities.

Implementing evidence-based practices to improve primary care for high-risk patients: study protocol for the VA high-RIsk VETerans (RIVET) type III effectiveness-implementation trial.

Background: Patients with significant multimorbidity and other factors that make healthcare challenging to access and coordinate are at high risk for poor health outcomes. Although most (93%) of Veterans' Health Administration (VHA) patients at high risk for hospitalization or death ("high-risk Veterans") are primarily managed by primary care teams, few of these teams have implemented evidence-based practices (EBPs) known to improve outcomes for the high-risk patient population's complex healthcare issues. Effective implementation strategies could increase adoption of these EBPs in primary care; however, the most effective implementation strategies to increase evidence-based care for high-risk patients are unknown.

Differential associations of mask mandates on COVID-19 infection and mortality by community social vulnerability.

Background: The COVID-19 pandemic in the United States has disproportionately impacted communities deemed vulnerable to disease outbreaks. Our objectives were to test (1) whether infection and mortality decreased in counties in the most vulnerable (highest) tercile of the Social Vulnerability Index (SVI), and (2) whether disparities between terciles of SVI were reduced, as the length of mask mandates increased.

Methods: Using the New York Times COVID-19 and the Centers for Disease Control and Prevention SVI and mask mandate datasets, we conducted negative binomial regression analyses of county-level COVID-19 cases and deaths from 1/2020-11/2021 on interactions of SVI and mask mandate durations.

Hospital Catchment Areas Characteristics and Geographic Regions Associated With Higher COVID-19 Veterans Health Administration Hospitalization During the Omicron Surge.

Context: Surges in the ongoing coronavirus-19 (COVID-19) pandemic and accompanying increases in hospitalizations continue to strain hospital systems. Identifying hospital-level characteristics associated with COVID-19 hospitalization rates and clusters of hospitalization "hot spots" can help with hospital system planning and resource allocation.

Objective: To identify (1) hospital catchment area-level characteristics associated with higher COVID-19 hospitalization rates and (2) geographic regions with high and low COVID-19 hospitalization rates across catchment areas during COVID-19 Omicron surge (December 20, 2021-April 3, 2022).

Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users.

Importance: Despite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation.

Objective: To examine the associations by race and ethnicity among California's Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19-related hospitalization.

Design, Setting, And Participants: This cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021.

Housing outcomes among homeless-experienced veterans engaged in vocational services.

Though unemployment and homelessness are closely intertwined, vocational services are rarely prioritized for homeless-experienced individuals engaging in housing services. Our goal was to examine associations between vocational service use and housing outcomes among homeless-experienced Veterans engaged in permanent supportive housing. We obtained data from Veterans Health Administration (VHA) medical record and homelessness registry data for homeless-experienced Veterans engaged in U.

Assessment of Exposure to Environmental Toxins and Racial and Ethnic Disparities in COVID-19 Hospitalizations Among US Veterans.

This cohort study examines whether exposure to environmental toxins mediates the association of racial and ethnic disparities with hospitalizations among US veterans with COVID-19.

Racial/Ethnic Variation in Veterans Health Administration COVID-19 Vaccine Uptake.

Introduction: Equitable COVID-19 vaccine access is imperative to mitigating negative COVID-19 impacts among racial/ethnic minorities. U.S.

COVID-19 Infection in the Veterans Health Administration: Gender-specific Racial and Ethnic Differences.

Purpose: Racial/ethnic minoritized groups, women, and economically disadvantaged groups are disproportionately affected by the COVID-19 pandemic. We investigated racial/ethnic differences by gender in correlates of COVID-19 infection among veterans seeking health care services at the Veterans Health Administration. Little is known about gender-specific factors associated with infection among veterans.

The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans.

Objectives: American Indian and Alaska Native (AI/AN) communities have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. This study examines whether neighborhood characteristics mediate AI/AN versus White-non-Hispanic Veteran COVID-19 infection disparities, and whether mediation differs based on proximity to reservations.

Methods: Using Veteran Health Administration's (VHA) national database of VHA users evaluated for COVID-19 infection (3/1/2020-8/25/2020), we examined whether census tract neighborhood characteristics (percent households overcrowded, without complete plumbing, without kitchen plumbing, and neighborhood socioeconomic status [n-SES]) mediated racial disparities in COVID-19 infection, using inverse odds-weighted logistic models controlling for individual-level characteristics.

Variations by race/ethnicity and time in Covid-19 testing among Veterans Health Administration users with COVID-19 symptoms or exposure.

Racial/ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalization and mortality have emerged in the United States, but less is known about whether similar differences exist in testing, and how this changed as COVID-19 knowledge and policies evolved. We examined racial/ethnic variations in COVID-19 testing over time among veterans who sought care for COVID-19 symptoms or exposure. In the national population of all Veterans who sought Veterans Health Administration (VHA) care for COVID-19 symptoms or exposure (n = 913,806), we conducted multivariate logistic regressions to explore race/ethnicity-by-time period differences in testing from 3/1/2020-11/25/2020, and calculated predicted probabilities by race/ethnicity and time period.

Healthcare service utilization for formerly homeless veterans in permanent supportive housing: Do neighborhoods matter?

Neighborhood characteristics are associated with residents' healthcare use. However, we understand less about these relationships among formerly homeless persons, who often have complex healthcare needs, including mental health and substance use disorders. Among formerly homeless Veterans, we examined: (a) how neighborhood characteristics are associated with Veteran Health Administration (VHA) healthcare use and, (b) if these relationships varied by Veterans' level of healthcare need.

Time Trends in Racial/Ethnic Differences in COVID-19 Infection and Mortality.

Studies documenting coronavirus disease 2019 (COVID-19) racial/ethnic disparities in the United States were limited to data from the initial few months of the pandemic, did not account for changes over time, and focused primarily on Black and Hispanic minority groups. To fill these gaps, we examined time trends in racial/ethnic disparities in COVID-19 infection and mortality. We used the Veteran Health Administration's (VHA) national database of veteran COVID-19 infections over three time periods: 3/1/2020-5/31/2020 (spring); 6/1/2020-8/31/2020 (summer); and 9/1/2020-11/25/2020 (fall).

Outcomes that Matter: High-Needs Patients' and Primary Care Leaders' Perspectives on an Intensive Primary Care Pilot.

Background: Quantitative evaluations of the effectiveness of intensive primary care (IPC) programs for high-needs patients have yielded mixed results for improving healthcare utilization, cost, and mortality. However, IPC programs may provide other value.

Objective: To understand the perspectives of high-needs patients and primary care facility leaders on the effects of a Veterans Affairs (VA) IPC program on patients.

BMI and Risk for Severe COVID-19 Among Veterans Health Administration Patients.

Objective: The purpose of this study was to assess associations between BMI and severe coronavirus disease 2019 (COVID-19) outcomes: hospitalization, intensive care unit (ICU) admission, and mortality. A secondary aim was to investigate whether associations varied by age.

Methods: The cohort comprised patients in the Veterans Health Administration (VHA) who tested positive for COVID-19 (N = 9,347).

Association of PTSD with COVID-19 testing and infection in the Veterans Health Administration.

Posttraumatic stress disorder (PTSD) is associated with coronavirus disease 2019 (COVID-19) risk factors, such as hypertension and obesity. Associations between PTSD and COVID-19 outcomes may affect Veterans Health Administration (VA) services, as PTSD occurs at higher rates among veterans than the general population. While previous research has identified the potential for increased PTSD prevalence resulting from COVID-19 as a public health concern, no known research examines the effect of pre-existing PTSD on COVID-19 test-seeking behavior or infection.

Relationship of neighborhood social determinants of health on racial/ethnic mortality disparities in US veterans-Mediation and moderating effects.

Objective: To examine mediation and moderation of racial/ethnic all-cause mortality disparities among Veteran Health Administration (VHA)-users by neighborhood deprivation and residential segregation.

Data Sources: Electronic medical records for 10/2008-9/2009 VHA-users linked to National Death Index, 2000 Area Deprivation Index, and 2006-2009 US Census.

Study Design: Racial/ethnic groups included American Indian/Alaskan Native (AI/AN), Asian, non-Hispanic black, Hispanic, Native Hawaiian/Other Pacific Islander, and non-Hispanic white (reference).