Association of Disability Compensation With Mortality and Hospitalizations Among Vietnam-Era Veterans With Diabetes

It remains poorly understood whether income assistance for adults with low income and disability improves health outcomes. This study examines the association between eligibility for disability compensation and mortality and hospitalizations among Vietnam-era veterans with diabetes. The researchers conduct a quasi-experimental cohort study of a July 2001 policy that expanded eligibility for disability compensation to veterans with “boots on the ground” (BOG) during the Vietnam era on the basis of a diagnosis of diabetes; veterans who were “not on ground” (NOG) remained ineligible. Eligibility for disability compensation was associated with marked reductions in hospitalizations but no changes in mortality.

Study participants were Vietnam-era veterans with diabetes in the Veterans Affairs Healthcare System. Difference-in-differences were estimated during early (July 2001-December 2007), middle (January 2008-December 2012), and later (January 2013-December 2018) postpolicy periods. Compared with NOG veterans, BOG veterans received $8025, $14412, and $17,162 more in annual disability compensation during the early, middle, and later postpolicy periods, respectively. Annual mortality rates were unchanged, with adjusted difference-in-differences of 0.24 percentage points (95% CI, −0.08 to 0.52), −0.08 percentage points (95% CI, −0.40 to 0.24), and −0.08 percentage points (95% CI, −0.48 to 0.36), during the early, middle, and later postpolicy periods. Among veterans with Medicare coverage in 1999, a population whose utilization could be completely observed in the data, BOG veterans experienced reductions of −7.52 hospitalizations per 100 person-years (95% CI, −13.12 to −1.92) during the early, −10.12 (95% CI, −17.28 to −3.00) in the middle, and −15.88 (95% CI, −24.00 to −7.76) in the later periods. These estimates represent relative declines of 10%, 13%, and 21%. Falsification tests of BOG and NOG veterans who were already receiving maximal disability compensation prior to the policy yielded null findings.