Homelessness Linked to End-Stage Kidney Disease, Death in Veterans with Incident Chronic Kidney Disease

For veterans with incident chronic kidney disease (CKD), a history of homelessness is associated with an increased risk for end-stage kidney disease (ESKD) and death, according to a study published online Sept. 10 in JAMA Network Open.

Alain K. Koyama, Sc.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues examined the association between a history of homelessness and the risk for ESKD and death in a retrospective cohort study conducted among veterans with stage 3 to 5 incident CKD. Data were included for 836,361 veterans: 32.8 and 32.4% were aged 65 to 74 years and 75 to 84 years, respectively.

The researchers found that 3.1% of the veterans developed ESKD and 43.0% died. Veterans with a history of homelessness had a significantly greater risk for ESKD than those who had not experienced homelessness (adjusted hazard ratio [aHR], 1.15; 95% confidence interval [CI], 1.10 to 1.20). They also had a greater risk for all-cause death (aHR, 1.48; 95% CI, 1.46 to 1.50).

The results were attenuated but remained significant for all-cause death (aHR, 1.09; 95% CI, 1.07 to 1.11) and were no longer statistically significant for ESKD after further adjustment for body mass index, comorbidities, and medication use (aHR, 1.04; 95% CI, 0.99 to 1.09).

"Potential interventions to improve CKD management may include tailored outreach to increase access to care in this population," the authors write. "Long-term solutions may require recognition of housing as a primary determinant of health and prioritization of housing to ensure adequate management of CKD and any other chronic conditions."

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