Cross-sectional Comparison of Social Drivers of Health in The Million Veteran Program and Behavioral Risk Factor...

Social drivers of health (SDOH) influence health, but there are few comparisons of SDOH and health among users of the Veterans Health Administration (VHA) and the broader Veteran community to support using SDOH variables in Veteran research. The objectives were to compare SDOH and health status between 2 cohorts of U.S. Veterans who independently participated in research programs that collected similar SDOH and general health information: the Department of Veterans Affairs (VA) Million Veteran Program (MVP) and the Behavioral Risk Factor Surveillance System (BRFSS).

Survey data for U.S. Veterans were collected 2011-2023 from MVP (N = 563,973) and BRFSS (N = 684,422) for demographics, health status, geography, education, income, employment, partnership status, household size, and social support. Cohorts were compared using standard mean differences (SMD) and sex-stratified Poisson models adjusting for age, race, and ethnicity. Absolute risk, risk differences, and risk ratios of favorable versus unfavorable SDOH for having better general health were reported.

Differences were small (SMD < 0.50) between the cohorts for demographics, general health, and all SDOH, except social support (females SMD: 0.89; males SMD: -0.73). Respective MVP and BRFSS differences for better health between favorable and unfavorable SDOH were significant, but small, for size of household among females, and all SDOH except geography among males. For both cohorts, SDOH risk ratios for better general health were greater than one, except household size among female MVP participants.

SDH among two large research programs of U.S. Veterans were similar and indicate that favorable SDOH are protective for general health. Considering social context will be useful in studies to improve understanding of risk, prevention and personalized treatment of disease among Veterans.