Investigating the association between Veteran status and rate of emergency department visits

Canadian Armed Forces (CAF) Veterans' use of emergency department (ED) services could provide insight into unmet primary health care needs, signal health crises, and support policy and program development.

This was a retrospective, matched cohort study of Ontario CAF and Royal Canadian Mounted Police Veterans and non-Veterans, using linked administrative databases at ICES. Ontario Veterans released between 1990 and 2019 were matched on age, sex, income, and geography to non-Veterans. Crude and adjusted relative ED visit rates were calculated using Andersen-Gill recurrent-event regression models. Effect modification by sex and length of service was investigated.

Crude ED visit rates of Veterans and matched non-Veterans were 3.20 (95% confidence interval [CI], 3.18-3.23) and 3.15 (95% CI, 3.13-3.16) per 10 person-years of follow-up time, respectively. The adjusted relative rate (RR) was 0.96 (95% CI, 0.93-0.98). The adjusted RR for male Veterans was significantly lower than that for non-Veterans, whereas the adjusted RR was similar for female Veterans and non-Veterans. Length of service was inversely associated with ED visitation rate. Veterans who served less than 5 years had a significantly higher ED visit rate than non-Veterans (RR = 1.17; 95% CI, 1.09-1.26), whereas Veterans who served for 30 years or more had a significantly lower ED visit rate than non-Veterans (RR = 0.78; 95% CI, 0.74-0.82).

Understanding what these different patterns mean for the design of health services and programs for female Veterans, and for those serving shorter durations, is needed to ensure relevant and timely support is provided.