By Stephen Spotswood
WASHINGTON — With more women leaving the military and becoming healthcare-eligible veterans, VA is focusing more energy and funding than ever into women’s health research.. Despite spending more money on women’s healthcare research in the last few years than in the previous three decades combined, however, the agency still has substantial knowledge gaps it is anxious to fill in.
Prior to the middle of the last decade, VA had little of its research portfolio directed at women veterans. In 2000, there were about 1.6 million women veterans (6% of the veteran population) — a large percentage of them from the Vietnam and Gulf War eras.
As hostilities in Iraq and Afghanistan continued through the decade and women made up a larger percentage of military forces (from14% in 2000 to 20% today), it became obvious that VA would have to begin funneling resources into women’s health. Today, the number of women using VA healthcare services is about 300,000 — more than twice the number of a decade ago.
“We first put together a comprehensive agenda on women’s health in 2004,” said Joel Coppersmith, MD, VA’s research chief. “Between 2004 and 2008, more research on the health of women veterans was published [by VA researchers] than in all previous years combined.”
In 2011, VA funded 60 studies on women’s health for a total investment of $12 million.
A lot of that research funding is going toward understanding exactly what this population looks like. In 2000, an age-distribution graph of women using VA care would have shown two peaks: one around age 44 and another around age 75. Today, the first peak is even larger, while the second would be found around age 85. Meanwhile, a substantial third peak has appeared around age 27, representing Iraq and Afghanistan veterans.
“As the number of women veterans has been growing, the age distribution has been shifting,” explained Susan Frayne, MD, associate director of the Women’s Health Center, VA Palo Alto. “VA must be equipped to address the needs of very young women, including sexual health and pregnancy.”
At the same time, VA cannot ignore the large group of women in their 50s and 60s who make up the population.
“Just 10 years from now, they’ll be in their 60s and early 70s, and their use of healthcare services will likely intensify as they develop late-life healthcare conditions,” Frayne said.
Improvement in VA’s care for women will be strongly linked to their improvement in mental-healthcare services, because 31% of female veterans have a diagnosed mental-healthcare condition, compared with 20% of male veterans. Most common is depression and PTSD.
“This suggests the importance of VA providing robust mental-health services for women veterans,” Frayne said. “In a one-year period, 37% of women veterans in VA used mental-health services at least once. This also supports the rationale of VA’s efforts to embed mental-health providers in primary-care settings.”
Despite their heavy use of mental-health services, the most common health conditions, seven out of eight, in women veterans are physical ailments, such as modifiable cardiovascular risk factors such as hypertension and obesity. Just as in its male population, VA needs research allowing physicians to intervene early with women veterans and avoid later complications from these diseases.
As of 2009, more than half of women receiving services at VA had a service-connected disability rating, the greatest number of whom were from the most recent generation of veterans.
Research on fibromyalgia, a poorly understood, chronically disabling pain syndrome, generally has focused on its clinical presentation and treatment.
The VA is expanding remote management of patients to improve disease prevention and care.