■在美国经历无家可归的成年人面临许多挑战,包括慢性肾脏病(CKD)的管理。在患有无家可归的CKD人群中,不良健康结果的潜在更大风险尚未得到充分探讨。
■评估无家可归史与终末期肾病(ESKD)风险和死亡之间的关联。
■这项回顾性队列研究于2005年1月1日至2017年12月31日进行。参与者包括18岁及以上的退伍军人,利用美国退伍军人健康管理局医疗保健网络,患有3至5期CKD。患者随访至2018年12月31日,观察ESKD的发生和死亡。从2022年9月到2023年10月进行了分析。
■无家可归的历史,根据退伍军人健康管理局或国际疾病分类对无家可归者服务的利用情况,第九次修订或国际疾病和相关健康问题统计分类,第十修订代码。在CKD事件索引日期之前的2年基线期间测量无家可归。
■主要结果是ESKD,在开始肾脏替代治疗的基础上,和全因死亡。计算调整后的危险比(HR),以比较有无家可归史的退伍军人和没有无家可归史的退伍军人。
■在836361名退伍军人中,最大的比例是65至74岁(274371名退伍军人[32.8%])或75至84岁(270890名退伍军人[32.4%]),809584(96.8%)为男性。共有26037名退伍军人(3.1%)患ESKD,死亡359991人(43.0%)。与没有经历过无家可归的退伍军人相比,那些有无家可归史的人表现出明显更大的ESKD风险(调整后的HR,1.15;95%CI,1.10-1.20)。还观察到全因死亡的风险更大(HR,1.48;95%CI,1.46-1.50)。在进一步调整体重指数后,合并症,和药物使用,全因死亡的结果减弱(HR,1.09;95%CI,1.07-1.11),对ESKD不再显著(HR,1.04;95%CI,0.99-1.09)。
■在这项针对3至5期CKD退伍军人的队列研究中,无家可归的历史与更大的ESKD和死亡风险显著相关,强调住房作为健康的社会决定因素的作用。
UNASSIGNED: Adults experiencing homelessness in the US face numerous challenges, including the management of chronic kidney disease (CKD). The extent of a potentially greater risk of adverse health outcomes in the population with CKD experiencing homelessness has not been adequately explored.
UNASSIGNED: To evaluate the association between a history of homelessness and the risk of end-stage kidney disease (ESKD) and death among veterans with incident CKD.
UNASSIGNED: This retrospective cohort study was conducted between January 1, 2005, and December 31, 2017. Participants included veterans aged 18 years and older with incident stage 3 to 5 CKD utilizing the Veterans Health Administration health care network in the US. Patients were followed-up through December 31, 2018, for the occurrence of ESKD and death. Analyses were performed from September 2022 to October 2023.
UNASSIGNED: History of homelessness, based on utilization of homeless services in the Veterans Health Administration or International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Homelessness was measured during the 2-year baseline period prior to the index date of incident CKD.
UNASSIGNED: The primary outcomes were ESKD, based on initiation of kidney replacement therapy, and all-cause death. Adjusted hazard ratios (HRs) were calculated to compare veterans with a history of homelessness with those without a history of homelessness.
UNASSIGNED: Among 836 361 veterans, the largest proportion were aged 65 to 74 years (274 371 veterans [32.8%]) or 75 to 84 years (270 890 veterans [32.4%]), and 809 584 (96.8%) were male. A total of 26 037 veterans (3.1%) developed ESKD, and 359 991 (43.0%) died. Compared with veterans who had not experienced homelessness, those with a history of homelessness showed a significantly greater risk of ESKD (adjusted HR, 1.15; 95% CI, 1.10-1.20). A greater risk of all-cause death was also observed (HR, 1.48; 95% CI, 1.46-1.50). After further adjustment for body mass index, comorbidities, and medication use, results were attenuated for all-cause death (HR, 1.09; 95% CI, 1.07-1.11) and were no longer significant for ESKD (HR, 1.04; 95% CI, 0.99-1.09).
UNASSIGNED: In this cohort study of veterans with incident stage 3 to 5 CKD, a history of homelessness was significantly associated with a greater risk of ESKD and death, underscoring the role of housing as a social determinant of health.