Beydoun Hind A, Beydoun May A, Khatana Sameed Ahmed M, Nixdorff Neil, Mishra Nishant K, Tsai Jack
VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC, USA.
Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
Geroscience. 2025 Jun 30. doi: 10.1007/s11357-025-01758-8.
Homelessness and chronic disease have been previously linked. We examined the bidirectional, sex-specific, relationship between homelessness and cerebrovascular disease among aging veterans seeking U.S. Department of Veterans Affairs (VA) healthcare services. A retrospective study was conducted among a cohort of 4,061,031 veterans (mean [± standard deviation] age: 68.7 [± 10.3] years; 94.6% men) followed between 2017 and 2021 and defined through linkage of VA Corporate Data Warehouse, Homeless Operations Management System, and Mortality Data Repository databases. Multivariable Cox regression models were constructed to bidirectionally examine associations between the first episode of homelessness and the first cerebrovascular disease event by sex. Multistate modeling was applied to examine sex differences in transitions from a healthy state to death through homelessness and cerebrovascular disease, adjusting for confounders. Overall, the earliest homelessness episode and earliest subsequent cerebrovascular disease event were negatively associated (hazard ratios (HR) = 0.30 [95% confidence intervals (CI): 0.29, 0.32]) among the 4,057,313 veterans who did not experience cerebrovascular disease before homelessness. Conversely, the earliest non-fatal hemorrhagic stroke event and earliest subsequent homelessness episode were positively associated (HR = 1.13, 95% CI: 1.04, 1.24) among the 4,059,465 veterans who did not experience homelessness before cerebrovascular disease. Female veterans were less likely than male veterans to transition from a healthy state to homelessness, stroke, or death. Irrespective of sex, veterans who experience homelessness may be less likely to be later diagnosed with cerebrovascular disease, while those who experience non-fatal hemorrhagic stroke may be more likely to later experience homelessness.
无家可归与慢性病之间的关联此前已有报道。我们研究了寻求美国退伍军人事务部（VA）医疗服务的老年退伍军人中，无家可归与脑血管疾病之间的双向、性别特异性关系。对2017年至2021年期间随访的4,061,031名退伍军人（平均[±标准差]年龄：68.7[±10.3]岁；94.6%为男性）进行了一项回顾性研究，这些退伍军人通过VA企业数据仓库、无家可归者运营管理系统和死亡率数据存储库数据库的链接确定。构建多变量Cox回归模型，以双向研究无家可归首次发作与首次脑血管疾病事件之间按性别的关联。应用多状态模型来研究从健康状态通过无家可归和脑血管疾病转变为死亡过程中的性别差异，并对混杂因素进行调整。总体而言，在无家可归前未患脑血管疾病的4,057,313名退伍军人中，最早的无家可归发作与随后最早的脑血管疾病事件呈负相关（风险比[HR]=0.30[95%置信区间（CI）：0.29,0.32]）。相反，在脑血管疾病前未经历无家可归的4,059,465名退伍军人中，最早的非致命性出血性中风事件与随后最早的无家可归发作呈正相关（HR=1.13，95%CI：1.04,1.24）。女性退伍军人从健康状态转变为无家可归、中风或死亡的可能性低于男性退伍军人。无论性别如何，经历无家可归的退伍军人随后被诊断患有脑血管疾病的可能性可能较小，而经历非致命性出血性中风的退伍军人随后经历无家可归的可能性可能较大。
