There was no significant between-group difference in unadjusted primary end point of @-year all-cause mortality ( @ % VA versus @ % non-VA ; hazard ratio associated with VA hospitals , @ ; @ % confidence interval , @-@ @ ) , which remained unchanged after adjustment for age and race ( hazard ratio , @ ; @ % confidence interval , @-@ @ ) or multivariable adjustment , including cardiovascular morbidities ( hazard ratio , @ ; @ % confidence interval , @-@ @ ) .