# Examining linkages between disrupted care and chronic disease outcomes during the COVID-19 pandemic: a VAMC level spatio-temporal analysis

> **NIH VA I01** · RALPH H JOHNSON VA MEDICAL CENTER · 2024 · —

## Abstract

ABSTRACT
Background: The global pandemic brought on by SARS-CoV-2 has profoundly impacted health and care for
veterans, who are generally older, sicker and more economically vulnerable than the overall U.S. population.
Veterans are likely to face lasting risks related to care disruptions. Understanding the long-term impact of these
disruptions and varied responses across VA Medical Centers (VAMC) is critical to understanding (1) primary
care needs moving forward, (2) identifying high risk patients for targeted interventions, and (3) reducing
disparities exacerbated by care disruptions.
Significance: Diabetes and hypertension are chronic conditions requiring substantial provider and patient care
to manage and result in high healthcare cost. Roughly, a quarter of all veterans receiving care at the VA have
diabetes and well over a third have hypertension. Diabetes and hypertension are associated with high
cardiovascular risk and lead to serious complications, including stroke, heart disease, kidney failure, amputation
and death. Racial, socioeconomic and geographic disparities in disease prevalence and progression are well
documented; hence, it is critical that we understand the impact of the pandemic with a particular focus on
“lessons learned” and health disparities that have widened.
Specific Aims: Our aims are (1) To determine the long-term impact of disrupted care on chronic disease
outcomes across the nation at the patient and VAMC level; (2) to identify veterans at high cardiovascular risk
as a result of disrupted care and determine the extent to which disparities with respect to race-ethnic group,
rural-urban residence and social vulnerability have widened during the pandemic; and (3) with input from our
advisory panel, create a Power BI dashboard of cardiovascular monitoring and risk to disseminate our results.
Methodology: We will create two retrospective cohorts of Veterans receiving primary care from 2017 through
2022: a diabetes and a hypertension cohort. Social vulnerability measures will be assigned at the census-tract
level based on a veterans’ residence. Our models are designed to investigate associations between individual-,
census tract- and VAMC- level factors, health care delivery metrics, and health outcomes using complex GIS
linkages and advanced spatio-temporal statistical methods. Delivery of care metrics include the extent to which
cardiovascular risk factors are monitored and their levels (when monitored) early in the pandemic. Outcomes
include prevalence of atherosclerotic cardiovascular disease (ASCVD), CVD risk levels, hospitalization, and
mortality. Aspects of our work that set it apart from ongoing projects are (1) our ability to include complete data
on inpatient hospital visits and emergency department visits when analyses are limited to South Carolina, (2)
the advanced statistical modeling that enables us to account for multiple factors at multiple levels (i.e., patient,
census tract, VAMC); and (3) the spatio-temp...

## Key facts

- **NIH application ID:** 10846624
- **Project number:** 5I01HX003577-02
- **Recipient organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** KELLY J HUNT
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-06-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10846624

## Citation

> US National Institutes of Health, RePORTER application 10846624, Examining linkages between disrupted care and chronic disease outcomes during the COVID-19 pandemic: a VAMC level spatio-temporal analysis (5I01HX003577-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10846624. Licensed CC0.

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