VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, District of Columba, USA.
Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA.
J Gerontol A Biol Sci Med Sci. 2024 Aug 1;79(8). doi: 10.1093/gerona/glae153.
Homelessness and housing instability disproportionately affect U.S. veterans with psychiatric disorders, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C, and Alzheimer's disease and related disorders (ADRD). We examined housing status and/or HIV/AIDS in relation to ADRD risk and evaluated hepatitis C, substance use, and mental health disorders as mediators and/or moderators of hypothesized relationships, among U.S. veterans ≥50 years of age seeking Department of Veterans Affairs (VA) healthcare services.
A retrospective cohort study was conducted using linked VA Homeless Operations Management and Evaluation System and Corporate Data Warehouse databases (2017-2023) on 3 275 098 eligible veterans yielding 133 388 ADRD cases over 5 years of follow-up. Multivariable regression and causal mediation analyses were performed, controlling for demographic and clinical characteristics.
Taking stably housed veterans without HIV/AIDS as referent, ADRD risk was higher among veterans with homelessness/housing instability alone (adjusted hazard ratio [aHR] = 1.67, 95% confidence interval [CI]: 1.63,1.72), lower among veterans with HIV/AIDS alone (aHR = 0.65, 95% CI: 0.58,0.73), but similar to veterans with homelessness/housing instability and HIV/AIDS (aHR = 1.01, 95% CI: 0.79,1.29). In adjusted models, hepatitis C and psychiatric disorders were positively related to homelessness/housing instability and ADRD risk, but negatively related to HIV/AIDS. Statistically significant mediation and/or moderation of hepatitis C and psychiatric disorders were observed, although <10% of total effects were explained by these characteristics, controlling for confounders.
Among older veterans, ADRD diagnoses over 5 years were less among those with HIV/AIDS, but more among those with homelessness/housing instability, and these relationships were partly explained by hepatitis C and psychiatric disorders.
无家可归和住房不稳定在美国患有精神障碍、人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）、丙型肝炎和阿尔茨海默病及相关疾病（ADRD）的退伍军人中不成比例地存在。我们研究了住房状况和/或 HIV/AIDS 与 ADRD 风险的关系，并评估了丙型肝炎、物质使用和心理健康障碍作为假设关系的中介和/或调节因素，这些关系存在于寻求退伍军人事务部（VA）医疗保健服务的年龄在 50 岁及以上的美国退伍军人中。
使用退伍军人事务部无家可归者运营管理和评估系统与公司数据仓库数据库（2017-2023 年）进行回顾性队列研究，对 3275098 名符合条件的退伍军人进行了研究，在 5 年的随访中产生了 133388 例 ADRD 病例。进行多变量回归和因果中介分析，同时控制人口统计学和临床特征。
以稳定住房且无 HIV/AIDS 的退伍军人为参照，仅患有无家可归/住房不稳定的退伍军人 ADRD 风险更高（调整后的危险比[aHR] = 1.67，95%置信区间[CI]：1.63，1.72），仅患有 HIV/AIDS 的退伍军人 ADRD 风险较低（aHR = 0.65，95%CI：0.58，0.73），但与同时患有无家可归/住房不稳定和 HIV/AIDS 的退伍军人相似（aHR = 1.01，95%CI：0.79，1.29）。在调整后的模型中，丙型肝炎和精神障碍与无家可归/住房不稳定和 ADRD 风险呈正相关，但与 HIV/AIDS 呈负相关。观察到丙型肝炎和精神障碍的统计学显著中介和/或调节作用，尽管这些特征仅解释了总效应的<10%，但控制了混杂因素。
在年龄较大的退伍军人中，5 年内的 ADRD 诊断在 HIV/AIDS 退伍军人中较少，但在无家可归/住房不稳定的退伍军人中较多，这些关系部分由丙型肝炎和精神障碍解释。
