Objectives: Approximately 10% of homeless adults in the US are veterans and that number is increasing. Veterans who experience homelessness tend to do so for longer periods compared to non-veterans; and homelessness is associated with more chronic disease complications. We compared the prevalence of five chronic, ambulatory-care sensitive conditions in homeless and domiciled individuals who received primary care at an urban VA hospital.
Methods: Data were obtained from the Veteran's Hospital Administration clinical data warehouse. Differences in disease prevalence were compared between the two groups using chi-square analyses and then adjusted for age, gender, race/ethnicity, BMI, and other risk factors where appropriate, using logistic regression. All analyses were conducted using SAS version 9.4.
Results: Homeless individuals were 46% more likely to have asthma (OR 1.46, 95% CI 1.16-1.84) and 40% more likely to have COPD (OR 1.40, 95% CI 1.14-1.73) after adjustment for age, gender, race/ethnicity, BMI, and tobacco use status. After adjustment for covariates, there was no difference between homeless and domiciled veterans in the prevalence of diabetes, hypertension, or congestive heart failure.
Discussion: Future quality improvement projects should identify social-environmental risk factors like employment characteristics, and housing quality that can impact chronic respiratory illness prevalence and associated complications.
Keywords: Veterans; ambulatory care; chronic disease; homelessness; primary care.