Academic journal article Journal of Rehabilitation Research & Development

Who Are the Women and Men in Veterans Health Administration's Current Spinal Cord Injury Population?

Academic journal article Journal of Rehabilitation Research & Development

Who Are the Women and Men in Veterans Health Administration's Current Spinal Cord Injury Population?

Article excerpt

INTRODUCTION

Spinal cord injury (SCI) has a profound effect on the injured person, close family members, and society as a whole. Between 231,000 and 311,000 people in the United States are living with SCI [1]. There are roughly 42,000 Veterans with SCI [2]; therefore, approximately one in five people with SCI in the United States are Veterans. About 25,000 Veterans with SCI receive their care from the Veterans Health Administration (VHA) [3]. The majority of Veterans with SCI have longstanding injuries. The characteristics of chronic injuries are not well represented by the available literature, which emphasizes the patterns of acutely injured individuals [4--6]. Thus, studying Veterans with SCI provides an ideal setting in which to characterize the clinical profile of individuals with chronic SCI.

The population of Veterans with SCI has undergone substantial changes over the last 40 years. After the Vietnam war, the number of Veterans with SCI increased, and there was a national effort to better understand SCI and its sequelae [7]. VHA was a leader in SCI care, with resultant remarkable achievements. It instituted fellowship programs focused on specialized training for comprehensive SCI care and established specialized SCI centers [8]. This improved SCI care has resulted in many Veterans aging with their SCIs and thus facing new medical challenges, such as shoulder arthritis and cardiovascular disease [9]. The composition of the Veteran population with SCI in VHA is also affected by an influx of new SCI injuries from current conflicts and an increase in the number of women in the military. Woman Veterans with SCI have unique healthcare needs, such as reproductive health and osteoporosis management [10]. A clear understanding of how the VHA SCI population is evolving over time is a high priority for caregivers and the healthcare system. Caregivers need to recognize emerging health needs related to living with SCI, and the system must understand the implications of these changes in order to optimize the allocation of scarce resources.

This descriptive study's goal is to provide an overview of the Veteran SCI population that uses VHA. This study characterizes demographics and use of healthcare among female and male Veterans with SCI and assesses whether the composition of the current Veteran SCI population differs from the SCI population that used VHA prior to the most recent conflicts in Iraq and Afghanistan.

METHODS

Overview

Data from the VHA National Patient Care Database (NPCD) were selected for analysis. This Department of Veterans Affairs (VA) database contains administrative and clinical data on inpatient and outpatient care, including visit dates, diagnoses, procedures, and patient demographic information. We performed descriptive analyses using two time periods: fiscal years (FY) 2002-2003 and FY2007-2008. The analyses assessed Veterans' demographic characteristics (age, race, marital status), injury status (paraplegia, quadriplegia, or unspecified), diagnoses (based on International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] diagnoses), and utilization patterns (based on clinic type codes). We included 2 years in each period because prior clinical work found that it took a 2-year interval to capture diagnoses for the majority of patients with SCI. We compared two time periods in order to capture secular shifts, including those associated with the recent conflicts in Iraq and Afghanistan.

Study Cohorts, 2002-2003 and 2007-2008

Using the NPCD outpatient and inpatient files, we first identified patients with SCI using the ICD-9-CM diagnosis codes (3440x, 3441, 806x, 9072, 952x). We reviewed all the diagnostic codes listed for each patient and excluded those patients with other neurologic diagnoses, such as multiple sclerosis, that could result in paralysis (33524, 33520, 340, 341x). We included only those who had a diagnosis of SCI from clinic stops where the patient was seen face-to-face by a clinician (i. …

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