In the U.S. Air Force (USAF), preventive care and disease management efforts are important elements of the healthcare system, as these directly impact the readiness of the active duty force. At this time, little is known about the presence of disparities in this arena.
De-identified clinical and administrative data from all active duty members in the USAF more than 12 months (N=298,549) were examined for differences in medical readiness outcomes and the prevalence and quality of care measures for hypertension, dyslipidemia, diabetes and asthma.
Chronic disease prevalence differed by race/ethnicity (p<0.0001). Non-Hispanic blacks were consistently more likely to be diagnosed with hypertension, dyslipidemia, diabetes, or asthma compared to non-Hispanic whites. Prevalence rates were also higher for other race/ethnicity categories, but less consistent. There was no evidence of disparity in the quality of care measures. Non-Hispanic white active duty members were least likely to have a current preventive health assessment (p<0.05), and non-Hispanic black active duty members were more likely (p<0.05) to be medically non-deployable.
The prevalence of chronic conditions also differed by rank category (p<0.0001), with senior enlisted members demonstrating a higher prevalence of hypertension, dyslipidemia, and diabetes (p<0.05). Predicted HbA1c results were consistently above the recommended treatment goal of 7.0% (p<0.05) for senior enlisted members with diabetes, although no other differences were noted in the remaining process or outcome measures. Except for older junior enlisted members, preventive health assessment currency was lowest for senior officers and medical non-deployability highest for senior enlisted members.
Chronic conditions also differed statistically significantly by gender (p<0.0001), with women more than twice as likely to have asthma (p<0.05). Treatment outcomes did not differ by gender, but younger women with diabetes were less likely to have a current HbA1c (p<0.05). Preventive health currency and medical non-deployability rates were not clinically significantly different.
A tremendous opportunity exists to improve the overall health of the USAF population through prevention of chronic diseases and the management of diabetes for senior enlisted members and younger women. However, the results of this study indicate that equal health benefits for this low risk population may alleviate the effect of health disparities.