Regional variation in financial hardship among US veterans during the COVID-19 pandemic
Authors: Hauschildt Katrina E , Bui David P , Govier Diana J , Eaton Tammy L , Viglianti Elizabeth M , Ettman Catherine K , McCready Holly , Smith Valerie A , O’Hare Ann M , Osborne Thomas F , Boyko Edward J , Ioannou George N , Maciejewski Matthew L , Bohnert Amy S B , Hynes Denise M , Iwashyna Theodore J ,   for the VA COVID-19 Observational Research Collaboratory (CORC), Chai Wen , Bowling Barrett , Maciejewski Matthew , Womer James , Iwashyna Theodore , Anderson Stacy , Bernstein Taylor , Cabrales Aissa , Hauschildt Katrina , Admon Andrew , Byrd Kaitland , Cano Jennifer , Curtis Jeffrey , DelMonico Emily , Horowitz Dana , Kamphius Lee , Korpela Peggy , Kumbier Kyle , Langa Kenneth , Prescott Hallie , Rouse Marylena , Saini Sameer , Seelye Sarah , Sussman Jeremy , Wawrin Natalya , Monahan Max , Bohnert Amy , Viglianti Elizabeth , Akgun Kathleen , Aslan Mihaela , Cheung Kei-Hoi , Li Yuli , Mutalik Pradeep , Rajeevan Nallakkandi , Yan Lei , Anderson Livia , Berkowitz Theodore , Bogdan Joseph , Bosworth Hayden , Boucher Nathan , Cummin Graham , Dennis Paul , Floyd Breana , Hastings Susan Nicole , Kaufman Brystana , Meyer Cassie , Miles Amy , Naylor Jennifer , Shepherd-Banigan Megan , Smith Valerie , Smith Battista , Woods Christopher , Dobalian Aram , Goetz Matthew , Ikuta Kevin , Ong Michael , Shaukat Aasma , Backus Lisa , Ferguson Jacqueline , Osborne Thomas , Shahoumian Troy , Veigulis Zachary , Zulman Donna , Bajema Kristina , Bui David , Chen Jason , Govier Diana , Helfand Mark , Hickok Alex , Hough Catherine , McCready Holly , Moss Abby , Newell Summer , Niederhausen Meike , Nugent Shannon , Saha Somnath , Slatore Christopher , Takata Yumie , Teo Alan , Tuepker Anais , Vranas Kelly , Winchell Kara , Hynes Denise , Boyko Edward , Au David , Baraff Aaron , Berry Wyatt Kristin , Borgerding Joleen , Burwick Nicholas , Crothers Kristina , Davis Marie , Doll Jacob , Dominitz Jason , Eastment McKenna , Fan Vincent , Fox Alexandra , Hawkins Eric , Hebert Paul , Hu Elaine , Korpak Anna , Morelli Daniel , Peterson Alexander , Reddy Ashok , Shah Javeed , Showalter Whitney , Smith Nicholas , Suri Pradeep , Thomas Eva , Turner Aaron , Vig Elizabeth , Wicks Katrina , Wong Edwin , Wysham Katherine , Ioannou George , O'Hare Ann , Jones Barbara , Jones Makoto , Knight Sara 
Published: June 2024

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.