Abstract: SA-OR033
Supportive Housing Participation and Risks of ESKD and Death in US Veterans Experiencing or at Risk for Homelessness
Session Information
- Diversity and Equity in Kidney Health: Research and Cases
November 08, 2025 | Location: Room 361A, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Yan, Guofen, University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Scialla, Julia J., University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Yu, Wei, University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Nelson, Richard E., University of Utah Health, Salt Lake City, Utah, United States
- Heng, Fei, University of North Florida, Jacksonville, Florida, United States
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Norris, Keith C., University of California Los Angeles, Los Angeles, California, United States
- Choudhury, Devasmita, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
- Cho, Monique E., University of Utah Health, Salt Lake City, Utah, United States
- Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
Background
Veterans with chronic kidney disease who experience homelessness face significantly higher risks of ESKD and death. We examined whether participation in supportive housing programs reduces these risks in the broader veteran population experiencing homelessness or housing instability.
Methods
We analyzed 480,159 veterans in the Veterans Health Administration (VHA) from 2003-2014 who were experiencing homelessness or at imminent risk, identified using (a) ICD-9/10 codes for homelessness or (b) VHA clinical stop codes related to homeless services. Veterans were classified into 3 groups based on program participation within 2 years after initial documentation: (1) supportive housing program (HUD-Veterans Affairs Supportive Housing or Grant and Per Diem), (2) Health Care for Homeless Veterans (HCHV) services only (outreach/emergency housing), and (3) no program participation (reference group). We estimated unadjusted and adjusted hazard ratios (HRs) for ESKD onset, pre-ESKD death, and their composite, controlling for age, sex, race/ethnicity, and year of initial documentation. Follow-up began after each person’s 2-year classification period (2005-2016) and continued for 5 years or until May 2018.
Results
The cohort had a mean age of 51 years; 90% male; 32% non-Hispanic Black, 55% non-Hispanic White, 6.4% Hispanic, and 6.6% other race/ethnicity. Within 2 years of initial documentation, 35% entered a supportive housing program, 51% entered HCHV only, and 14% participated in neither. Compared to non-participants, those in supportive housing had 14%, 18%, and 18% lower adjusted risks of ESKD, pre-ESKD death, and the composite outcome, respectively (Table). Veterans in HCHV program had 17%, 20%, and 20% lower adjusted risks for the same outcomes.
Conclusion
Participation in supportive housing or HCHV was associated with reduced risks of ESKD and death among homeless or at-risk veterans. These findings support the critical role of housing interventions to improve kidney health outcomes in individuals facing housing instability.
Table. Comparison of ESKD-related outcomes among program participants versus non-participants
| ESKD onset | Pre-ESKD death | Composite (ESKD or pre-ESKD death) | ||||
| Unadjusted HR (95% CI) | Adjusted HR (95% CI) | Unadjusted HR (95% CI) | Adjusted HR (95% CI) | Unadjusted HR (95% CI) | Adjusted HR (95% CI) | |
| Housing vs. reference | 0.74 (0.66-0.83) | 0.86 (0.77-0.98) | 0.52 (0.51-0.54) | 0.82 (0.80-0.84) | 0.53 (0.52-0.54) | 0.82 (0.80-0.84) |
| HCHV vs. reference | 0.81 (0.73-0.90) | 0.83 (0.75-0.92) | 0.65 (0.64-0.66) | 0.80 (0.78-0.81) | 0.66 (0.64-0.67) | 0.80 (0.78-0.81) |
Funding
- NIDDK Support