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Objective: The COVID‐19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all‐cause mortality during the COVID‐19 pandemic, stratified by race and ethnicity. Data Sources: Administrative data from the Veterans Health Administration's Corporate Data Warehouse. Study Design: We use pre‐pandemic data to estimate mortality risk models using five‐fold cross‐validation and quasi‐Poisson regression. Models were stratified by a combined race‐ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. Data Collection: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016–2020. Veterans were excluded from analyses if they were missing county of residence or race‐ethnicity data. Data were then aggregated to the county‐year level and stratified by race‐ethnicity. Principal Findings: Overall, Veterans' mortality rates were 16% above normal during March–December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non‐Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%–24%), while Native American Veterans had the highest increase (40%, 95% CI 17%–73%). Black Veterans (32%, 95% CI 27%–39%) and Hispanic Veterans (26%, 95% CI 17%–36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. Conclusions: Minoritized Veterans experienced higher rates excess of mortality during the COVID‐19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long‐standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities. [ABSTRACT FROM AUTHOR]

The Foundations for Evidence-Based Policymaking Act of 2018 requires cabinet-level agencies to use evidence to justify and support budget and policy making. As investigators from the Quality Enhancement Research Initiative (QUERI) program, we were tasked with assisting Veterans Health Administration (VHA) leadership with the implementation of the Evidence-Based Policymaking Act of 2018. Through meetings with stakeholders, we identified a gap in the review process for legislative and budget proposals; no systematic process existed to evaluate the supporting evidence base for proposals. Here, we describe the development, refinement, and use of a checklist to assess the strength of evidence included in VHA legislative and budget proposals for changes to care delivery; clinical, research, and administrative operations; and staffing and workforce issues. The evidence assessment checklist is now part of the regular review process for VHA legislative and budget proposals. It is also being adapted for use elsewhere within the Department of Veterans Affairs. The checklist has provided a framework for briefings and training on best practices for using evidence to guide policy and budget decisions. Including evidence reviews in the legislative and budget proposal prioritization process may be an effective institutional arrangement to promote the use of evidence to inform high-level health policy decisions and to build a "culture of evidence" within the government. • The Veterans Health Administration's experience with evidence-based medicine made it well positioned to strengthen the link between evidence and budget and policy decisions, in compliance with the Foundations for Evidence-Based Policymaking Act of 2018. • We describe the development, refinement, and use of a checklist to assess the strength of evidence included in Veterans Health Administration legislative and budget proposals. [ABSTRACT FROM AUTHOR]