Regional variation in financial hardship among US veterans during the COVID-19 pandemic

Abstract

Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform. Regional variation in veteran financial hardship demonstrates a need for further research about the role and interaction of federal and state financial-assistance policies in shaping risks for financial hardship as well as potential opportunities to mitigate risks among veterans and reduce variation across regions.

Keywords: ADI; COVID-19; census region; employment; financial hardship; veterans.

Figure 1.

Adjusted probabilities of financial hardship outcomes by US Census region (included in Table S2). Census regions are represented by horizontal bars next to each outcome, from top to bottom (South, West, Midwest, Northeast) and by the following colors: red = South; orange = West; light blue = Midwest; dark blue = Northeast. Predicted probabilities are adjusted for age, sex, race/ethnicity, Gagne comorbidity index, distance to VA medical center; and ADI. *P ≤ .05 (compared with South region); based on z-test of average marginal effect. Abbreviations: ADI, Area Deprivation Index; VA, Department of Veterans Affairs.