Panadero Talia J, Gabrielian Sonya, Seamans Marissa J, Gelberg Lillian, Tsai Jack, Harris Taylor
Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), Department of Veteran Affairs (VA) Greater Los Angeles, Los Angeles, CA, USA.
Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Greater Los Angeles, Los Angeles, CA, USA.
BMC Public Health. 2025 Jan 28;25(1):355. doi: 10.1186/s12889-024-21169-2.
Permanent supportive housing (PSH) is an evidence-based practice for reducing homelessness that subsidizes permanent, independent housing and provides case management-including linkages to health services. Substance use disorders (SUDs) are common contributing factors towards premature, unwanted ("negative") PSH exits; little is known about racial/ethnic differences in negative PSH exits among residents with SUDs. Within the nation's largest PSH program at the Department of Veterans Affairs (VA), we examined relationships among SUDs and negative PSH exits (for up to five years post-PSH move-in) across racial/ethnic subgroups.
We used VA administrative data to identify a cohort of homeless-experienced Veterans (HEVs) (n = 2,712) who were housed through VA Greater Los Angeles' PSH program from 2016-2019. We analyzed negative PSH exits by HEVs with and without SUDs across racial/ethnic subgroups (i.e., African American/Black, Non-Hispanic White, Hispanic/Latino, and Other/Mixed [Asian, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander, and mixed race/ethnicity]) in controlled models and accounting for competing risk of death.
In competing risk models, HEVs with at least one SUD had 1.3 times the hazard of negative PSH exits compared to those without SUDs (95% CI: 1.00, 1.61). When stratifying by race/ethnicity, Other/Mixed race residents with at least one SUD had 6.4 times the hazard of negative PSH exits compared to their peers without SUDs (95% CI: 1.61-25.50). Hispanic/Latino residents with at least one SUD had 1.9 times the hazard compared to those without SUDs; however, this association was not statistically significant (95% CI: 0.85-4.37). African American/Black residents with at least one SUD had 1.2 times the hazard compared to those without SUDs (95% CI: 0.85-1.64), indicating no evidence of an association with negative PSH exits. Non-Hispanic White residents with at least one SUD had 1.1 times the hazard compared to those without SUDs (95% CI: 0.75-1.66), similarly indicating no evidence to suggest an association with negative PSH exits.
These findings suggest relationships between SUDs and negative PSH exits differ between racial/ethnic groups and suggest there may be value in culturally specific tailoring and implementation of SUD services for these subgroups.
永久性支持性住房（PSH）是一种基于证据的减少无家可归现象的做法，它补贴永久性独立住房，并提供个案管理，包括与医疗服务的联系。物质使用障碍（SUDs）是导致过早、意外（“负面”）离开PSH的常见因素；对于患有SUDs的居民中负面PSH退出的种族/民族差异知之甚少。在退伍军人事务部（VA）最大的PSH项目中，我们研究了不同种族/民族亚组中SUDs与负面PSH退出（PSH入住后长达五年）之间的关系。
我们使用VA行政数据确定了一组有过无家可归经历的退伍军人（HEVs）（n = 2712），他们在2016年至2019年期间通过VA大洛杉矶地区的PSH项目获得了住房。我们在控制模型中并考虑死亡的竞争风险，分析了有无SUDs的HEVs在不同种族/民族亚组（即非裔美国人/黑人、非西班牙裔白人、西班牙裔/拉丁裔以及其他/混合[亚洲人、美洲印第安人或阿拉斯加原住民、夏威夷原住民或其他太平洋岛民以及混合种族/民族]）中的负面PSH退出情况。
在竞争风险模型中，至少患有一种SUD的HEVs负面PSH退出的风险是没有SUDs的HEVs的1.3倍（95%置信区间：1.00，1.61）。按种族/民族分层时，至少患有一种SUD的其他/混合种族居民负面PSH退出的风险是没有SUDs的同龄人6.4倍（95%置信区间：1.61 - 25.50）。至少患有一种SUD的西班牙裔/拉丁裔居民风险是没有SUDs居民的1.9倍；然而，这种关联在统计学上不显著（95%置信区间：0.85 - 4.37）。至少患有一种SUD的非裔美国人/黑人居民风险是没有SUDs居民的1.2倍（95%置信区间：0.85 - 1.64），表明没有证据显示与负面PSH退出有关联。至少患有一种SUD的非西班牙裔白人居民风险是没有SUDs居民的1.1倍（95%置信区间：0.75 - 1.66），同样表明没有证据表明与负面PSH退出有关联。
这些发现表明，SUDs与负面PSH退出之间的关系在不同种族/民族群体中存在差异，这表明针对这些亚组进行文化上特定的SUD服务定制和实施可能具有价值。
