The impact of multi-systems utilization on the health outcomes of Mississippi Veterans experiencing stroke: Policy implications

Abstract:Stroke poses a global threat, as it is the third-leading cause of disability and the secondleading cause of death worldwide (Owolab et al., 2022). In the United States, someone has a stroke every 40 seconds, and a person dies of a stroke every 3.5 minutes (CDC, 2022). The Mississippi Department of Health advises that “stroke is one of the top five causes of death in the state, claiming about 1,500 Mississippians each year” (MSDH, 2023). A segment of the Mississippi population experiencing stroke includes its military veterans. Despite being preventable and treatable, Mississippians remain vulnerable to stroke risk factors, and stroke persists as one of the leading causes of death and disability in Mississippi and the United States. This study uses secondary data from the Behavioral Risk Factor Surveillance System (BRFSS) to investigate if multiple system utilization patterns exacerbate poor health outcomes forMississippi veterans surviving stroke who received care from providers within or external to the Veterans Healthcare Administration system. Data from the Behavioral Risk Factor Surveillance System (BRFSS) 2018 – 2022 reporting periods were uploaded to Statistical Package for Social Science (SPSS) software version 29.0. The sample population was derived by filtering veteran status and stroke diagnosis variables from the Mississippi respondent population, resulting in a final dataset with a population sample size of 379 unique records for Mississippi military stroke survivors. Complex logistic regression analysis evaluated the relationships between multiple systems utilization and cognitive impairment and health insurance coverage. Nearly a quarter of the sample population (23.2%) utilized multiple systems, obtaining services from more than one healthcare provider, and some form of health insurance was used by 86% of participants, with just over a quarter of the population ( 26.1%) reporting cognitive impairment. Study findings determined that when controlling for selected demographics in the study population, there is no strong evidence that multiple healthcare system use is associated with cognitive impairment (p = 0.167). Being married shows a potential protective effect against cognitive impairment, but it is only borderline statistically significant. Other predictors(education and employment) do not show significant effects.When controlling for selected demographics in the study population, there is not strong enough evidence to conclude that multiple healthcare system use is associated with healthcare insurance coverage. Being employed shows a positive influence on participation in insurance coverage, and other predictors (marital status, level of education, employment, having a regular doctor) do not show significant effects. However, the overall model does significantly predict cognitive impairment (p = 0.019).