Health-Related Social Needs and Outpatient and Emergency Department Use Among US Women Veterans: NHIS 2015-2018

Diana J Govier; Claire T Than; Elisheva R Danan; Neetu Chawla; Katherine J Hoggatt; Elizabeth M Yano; Denise M Hynes

doi:10.1007/s11606-025-09952-2

Health-Related Social Needs and Outpatient and Emergency Department Use Among US Women Veterans: NHIS 2015-2018

J Gen Intern Med. 2025 Dec 19. doi: 10.1007/s11606-025-09952-2. Online ahead of print.

Authors

Diana J Govier^{1

2

3}, Claire T Than⁴, Elisheva R Danan^{5

6

7}, Neetu Chawla⁸, Katherine J Hoggatt^{9

10}, Elizabeth M Yano^{8

11

12}, Denise M Hynes^{13

14

15}

Affiliations

¹ Veterans Rural Health Resource Center - Portland, VHA Office of Rural Health, Portland, OR, USA. Diana.Govier@va.gov.
² VA Health Systems Research (HSR) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA. Diana.Govier@va.gov.
³ Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, USA. Diana.Govier@va.gov.
⁴ VHA National Oncology Program, Specialty Care Services, Washington, DC, USA.
⁵ VA HSR Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis, MN, USA.
⁶ Division of General Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN, USA.
⁷ epartment of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
⁸ VA HSR Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁹ VA HSR Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System, San Francisco, CA, USA.
¹⁰ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
¹¹ Division of General Internal Medicine and Health Sciences Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA.
¹² Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
¹³ VA Health Systems Research (HSR) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.
¹⁴ College of Health and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA.
¹⁵ School of Nursing, Oregon Health and Science University, Portland, OR, USA.

PMID: 41417451
DOI: 10.1007/s11606-025-09952-2

Abstract

Background: Women Veterans are a rapidly growing population for whom health-related social needs (HRSNs) may influence their health care use within Veterans Health Administration (VA) and non-VA health care systems.

Objective: Using nationally representative survey data, we characterized and compared the prevalence of HRSNs among women Veterans with and without VA health care coverage and examined associations between the accumulation of HRSNs and women Veterans' outpatient and emergency department use.

Design: This was a retrospective observational study. We pooled 2015-2018 National Health Interview Survey (NHIS) data on women Veterans' characteristics, HRSNs, and health care use. Descriptive statistics were computed overall and by VA coverage status, accounting for NHIS survey design. Multivariable linear probability models for associations between accumulation of HRSNs and past-year outpatient and ED use were estimated, accounting for sociodemographic and clinical factors and NHIS survey design.

Participants: 1,035 women Veteran NHIS respondents.

Main measures: 47 binary HRSN variables across six HRSN domains: economic stability, housing, community/social context, food security, education, and health care system; variables for HRSNs count and quartile; and binary variables for any past-year outpatient and emergency department (ED) use.

Key results: Overall, 61% of women Veterans had ≥ 4 HRSNs (of 47 possible); the most common HRSNs were those related to economic stability and the health care system. Women Veterans with VA coverage had more HRSNs than those without VA coverage (mean: 8, SE: 0.5 vs. mean: 6, SE: 0.3, p = 0.036). In adjusted regression analyses, women Veterans with the greatest accumulation of HRSNs (≥ 8 needs; quartile 4) were less likely to have utilized outpatient services (-7.9 percentage points, 95% CI: -14.8, -1.1) and more likely to have utilized ED services (13.1 percentage points, 95% CI: 4.0, 22.3) in the past year compared with women Veterans with the lowest accumulation of HRSNs (≤ 1 needs; quartile 1).

Conclusions: Interventions are needed to address HRSNs and downstream impacts among women Veterans.

Keywords: emergency department; health care coverage; health-related social needs; women veterans; outpatient care.

Abstract

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