Homefront: Black Veterans and Black Voters in the Civil Rights Era

While the role of World War II veterans in the civil rights movement has been well documented, debate about the causal effect of military service remains. Combining detailed information on World War II enlistments and Civil Rights Commission data on voter registration, we present the first causal estimates of the role of Black veterans in high-risk political participation in the US South. Each Black enlistee increased Black voter registration by more than two additional Black registrants after the Voting Rights Act of 1965. We find similar effects on the presence of Black rights groups and, in response, White nationalist organizations.

Impact of equal access healthcare on race disparities in bladder cancer.

399 Background: Outcomes in bladder cancer are disproportionately worse for black patients compared to white patients. We hypothesize these disparities arise in part due to differences in access to healthcare and therefore may be mitigated in an equal access healthcare system, such as the Veterans Affairs’ (VA) system. Here, we examine outcomes by race for patients with bladder cancer within the VA system and then compare these outcomes to those in the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We performed a retrospective cohort study using VA Informatics and Computing Infrastructure (VINCI) and SEER. We included all patients diagnosed with bladder cancer, American Joint Committee on Cancer (AJCC) stage 0-4 diagnosed between 2000 and 2018. Endpoints of overall survival (OS), bladder cancer-specific survival (BCS), and non-bladder cancer-specific survival (NCS) were evaluated in multivariable Cox and Fine-Gray models. Results: Using the VA dataset, we identified 36322 veterans (9.0% black, 91.0% white) with bladder cancer. Black veterans were more likely to have more comorbidities, reside in zip codes with lower median income and education levels, and present with higher stage disease (AJCC stages 2-4) than white veterans (23.3% vs 19%). In multivariable models accounting for disease stage among other covariables, there were no statistically significant differences in any survival endpoint (Table). Using the SEER dataset, we identified 130998 patients (5.9% black, 94.1% white) with bladder cancer. In similar multivariable models, SEER’s black patients had statistically significant inferior outcomes in all survival endpoints compared to SEER’s white patients (Table). Conclusions: While racial disparities for patients with bladder cancer in the SEER database were observed, no differences in survival outcomes between black and white patients were observed in the VA healthcare system. Of note, black veterans presented with more advanced stage, suggesting a delay in diagnosis or a more aggressive cancer phenotype compared to white patients. Our findings underscore the need to bridge healthcare disparities across diverse racial groups. Our study highlights the beneficial impact of an equal access healthcare system in reducing financial and social barriers to healthcare to counteract racial health disparities. Further research is required to delineate these disparities and guide appropriate screening strategies. [Table: see text]

Vicious Habits

We analyze a random sample of 15,049 white veterans and 5,329 black veterans of the US Civil War examined by physicians between 1890 and 1906. We calculate a period prevalence of STI of 1.2–1.7 % among whites and 4.2–8.0 % among blacks, even though blacks and whites had almost identical prevalence of STI s in their wartime medical records. Furthermore, we find evidence that Board physicians were on the lookout for STI s among black veterans that could be used to justify denial of pension support. With or without STI s, blacks were rejected at roughly twice the rate of whites during this time period. Currently, racial disparities are even higher today than in this historical period, with blacks currently having a 5–15 times higher incidence than whites. We invite a critical reflection upon practices of screening and measurement systems to assess properly the degree to which racial prejudice may be part of these systems.

Dementia and Cognitive Impairment Among U.S. Veterans With a History of MDD or PTSD: A Retrospective Cohort Study Based on Sex and Race

Objective: The aim of this study was to examine major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) diagnosed at age < 55 as predictors, and sex and race as potential moderators, of dementia and other forms of cognitive impairment. Method: Veterans ( N = 4,800) aged ⩾ 56 years were grouped by psychiatric history, sex, and race. Hierarchical and stepwise regression were employed to determine significant predictors. Results: MDD and PTSD were associated with almost double the risk for developing dementia or cognitive impairment at age ⩾ 56. Sex, as a moderator, had small effects whereas race increased the risk almost twofold for Black veterans, given the presence of MDD history. Discussion: MDD and PTSD act as significant risk factors for dementia and other forms of cognitive impairment, and Black veterans, given a history of MDD, may be at an increased risk. An important endeavor for future research is to examine how this risk may vary across dementia subtypes and related conditions.