This study is a descriptive analysis of cross-sectional data from respondents to the 2007–2009 surveys of the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an annual random-digit–dialed telephone survey in all 50 US states, the District of Columbia, Puerto Rico, the Virgin Islands, and the US Pacific territories (24
). Eligible participants are adults (1 per household) aged 18 years or older interviewed about their health status, access to health care, and health behaviors. The Centers for Disease Control and Prevention (CDC) institutional review board has reviewed and approved the BRFSS protocol. The BRFSS method, design, questionnaires, and data sets are available in the public domain (24
Of 1,278,028 participants in the 2007–2009 BRFSS, 801,862 (63%) answered a question about their status as a veteran (see definition below) and identified themselves as either non-Hispanic whites, non-Hispanic blacks, American Indians/Alaska Natives, or Hispanics. Twelve percent (n = 110,365) of these reported being a veteran, 100,829 (92%) men and 9,536 (8%) women (values are weighted). We compared veterans and their civilian counterparts within racial/ethnic groups by age, marital status, educational level, employment status, annual income, and HRQOL.
The HRQOL items used for this study were self-rated health (excellent, very good, good, fair, or poor), physically unhealthy days (the number of days during the past 30 days when one’s physical health was not good), mentally unhealthy days (the number of days during the past 30 days when one’s mental health was not good), and recent activity limitation days (the number of days during the past 30 days when one’s physical or mental health kept one from doing one’s usual activities). The question about veteran status remained the same during the 2007–2009 BRFSS surveys: “Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.” However, the response choices differed in the 2009 questionnaires from those in the 2008 and 2007 questionnaires. In 2009, participants chose from 7 responses: 1) yes, now on active duty; 2) yes, on active duty during the last 12 months, but not now; 3) yes, on active duty in the past, but not during the last 12 months; 4) no, training for Reserves or National Guard only; 5) no, never served in the military; 6) don’t know/not sure; and 7) refused. In the 2007 and 2008 BRFSS, there were 4 choices: yes, no, don’t know/not sure, and refused. For this study, we defined veterans as those answering yes to these questions on any of the 3 surveys and civilians as those answering no to these questions. We excluded from the analysis those answering don’t know/not sure and those refusing to answer these questions.
The demographic characteristics analyzed were the following: race/ethnicity (non-Hispanic white, non-Hispanic black, American Indian/Alaska Native, or Hispanic); age group (18–24, 25–34, 35–44, 45–54, 55–64, or ≥65 y), marital status (currently married or not), educational level (≤high school, attended college or technical school, or graduated from college or technical school), employment status (currently employed for wages or self-employed, not currently employed [includes the unemployed, students, homemakers, or unable to work], or retired), and annual household income (<$15,000, $15,000–$24,999, $25,000–$34,999, $35,000–$49,999, or ≥$50,000).
To account for the BRFSS complex sample design and sampling weights, we used SAS-callable SUDAAN version 9.2 (RTI International, Research Triangle Park, North Carolina) to estimate demographic characteristics and self-rated health and mean unhealthy days by veteran status and race/ethnicity, both unadjusted and adjusted for sex, age group, marital status, educational level, employment status, and annual household income. Nonoverlapping 95% confidence intervals of means statistically distinguished veterans and civilians of different racial/ethnic groups.