The COVID-19 pandemic affected healthcare utilization, particularly for populations with chronic disease. This study examined impact of the COVID-19 pandemic on Emergency Department (ED) visits among adults with diabetes in the U.S. We conducted a cross-sectional analysis of adults with diabetes using deidentified, publicly available data from the 2019–2021 National Health Interview Survey (NHIS). The primary independent variable was survey year: 2019 (pre-COVID-19 era) and 2020–2021 (COVID era). The outcome variable was any ED visit in the last 12 months. We conducted multivariable logistic regression to estimate the difference in ED visits before and during the COVID-19 pandemic among adults with diabetes. We estimated adjusted odds ratios and 95% confidence intervals adjusting for healthcare access, self-reported health status, demographic, and socioeconomic characteristics. The sample consisted of 9,845 adults with diabetes (3,066 in 2019, 3,086 in 2020, and 2,899 in 2021). Of these, 19.5% were immigrants, 15.6% Non-Hispanic Black, 17.2% Hispanic, and 58.5% Non-Hispanic White. People with diabetes were 15% in 2020 [AOR 0.85 (95% CI 0.73–0.98)] and 24% in 2021 [AOR 0.76 (95% CI 0.65–0.88)] less likely to visit ED compared to 2019. Delayed care due to cost was significantly associated with increased odds (AOR 1.65; 95% CI 1.32, 2.06) of ED visits compared to those who did not delay their care due to cost. Having fair or poor health status was associated with higher odds of ED visits (AOR 2.01; 95% CI 1.68, 2.41) compared to those reporting excellent health status. Limited access to routine care during the COVID-19 pandemic for diabetes should have led to increased ED visits but the study found significant reduction in ED visits compared to pre-pandemic in people living with diabetes. Future studies are needed to examine whether the reductions in ER were derived from better telemedicine use or avoidance of using necessary care. Also, studies are needed for developing solutions that preserves healthcare delivery in public health care crisis.

Veterans commonly experience both poor health and employment difficulty. However, the research examining potential relationships between chronic physical and mental health conditions and employment in veterans has important limitations. This study examines those potential relationships using large-scale, nationally representative data. The authors' hypothesis was that veterans experiencing these conditions would be less likely to be employed than veterans without the conditions and, further, that there may be differences in these relationships when comparing male veterans with female veterans. The study team conducted a pooled cross-sectional analysis of nationally representative data from the 2004-2019 administrations of the Medical Expenditures Panel Survey, which had items addressing health conditions, employment, and military experience. The authors assessed the relationship between health conditions and employment using multivariate logistic regression. Control variables included demographics, SES, family size, and survey year. Veterans experiencing diabetes, high blood pressure, stroke, emphysema, arthritis, serious hearing loss, poor self-reported mental health, poor self-reported health, depression, or psychological distress were less likely to be employed than veterans without those conditions, even after adjusting for potential confounding factors. Veterans with diabetes had 25% lesser odds of being employed than veterans without the condition (95% CI=0.65, 0.85). Veterans with increased likelihood of depression had 35% lesser odds of being employed than veterans without depression (95% CI=0.52, 0.81). This study adds evidence to the understanding of the role of chronic health conditions in employment status of veterans. The results support arguments for programs that aid veterans with both their health and their employment.

Introduction: Post-9/11 U.S. veterans experience disproportionately high rates of mental health conditions. They are also more likely than non-veterans to be unemployed. Many studies have examined potential relationships between those phenomena. We aimed to systematically review this literature. Materials and Methods: Articles published between September 2001 and September 2021 were identified using PubMed, Web of Science, and Google Scholar. These studies were cohort, cross-sectional, mixed methods, or qualitative studies that reported associations between mental health status or diagnoses and employment and were published in English. Primary mental health conditions of interest were post-traumatic stress disorder (PTSD), alcohol use disorder, bipolar disorder, depression, and other mood, psychiatric, or eating disorders. Two authors screened identified articles for inclusion, and disagreements were resolved by a third author. Results: Twenty-eight articles met inclusion criteria. Three reported PTSD to be positively associated with unemployment, although 7 found null results. Seven of 9 studies examining depression found positive associations between depression and unemployment, with 2 studies showing null findings. One study reported impaired job performance among veterans with alcohol or substance use disorder, but 2 studies on alcohol use disorder reported no significant association with unemployment. Study methodologies varied significantly, including in their populations, employment definitions, and choice of potential confounders. Conclusions: The review suggests a relationship between depression and employment status, but evidence for relationships between other conditions and employment status is mixed, which may be because of significant methodological differences between individual studies. Future work should address this by using a generalizable sample of post-9/11 veterans, a standardized definition of unemployment, and base the statistical model on a theoretical framework describing the relationship between mental health and employment.