Examining veteran housing instability and mortality by homicide, suicide, and unintentional injury

ABSTRACT

To examine the relationship between Veterans’ housing instability and mortality by homicide, suicide, and unintentional injury, this retrospective study examined administrative data from Veterans Health Administration (VHA) patients who responded to the Homelessness Screening Clinical Reminder (HSCR) between October 1, 2012 and September 30, 2016 and were searched through the National Death Index (NDI) for date and cause of death (N = 5,850,044). Analyses calculated survival time and compared mortality for three groups—(1) stably housed Veterans, (2) unstably housed Veterans, and (3) Veterans at imminent risk for housing instability—using adjusted Cox proportional hazards models. Stably housed Veterans had a significantly longer median survival time (3.3 years) than unstably housed Veterans and those at imminent risk for housing instability (2.5 and 2.6 years, respectively). Unstably housed Veterans and those at imminent risk for housing instability had greater risk of all-cause mortality (Adjusted Hazard Ratio [aHR] = 1.69 and 1.48, respectively) and of dying by homicide (aHR = 3.01 and 2.65, respectively), suicide (aHR = 1.75 and aHR = 1.80, respectively), and unintentional injury (aHR = 3.13 and aHR = 1.92, respectively) compared with stably housed Veterans. More proactive measures are needed to prevent external causes of mortality among Veterans who are unstably housed or at imminent risk for housing instability.

KEYWORDS:

• homelessness
• housing instability
• suicide
• mortality
• external causes of death

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs (VA) HSR&D IIR 13–334 and intramural research funding from the VA National Center on Homelessness among Veterans.

Notes on contributors

Meagan Cusack

Meagan Cusack is pursuing a PhD is social welfare from the University of Pennsylvania School of Social Policy and Practice while working as a Health Science Specialist at the U.S. Department of Veterans Affairs (VA) Center for Health Equity Research and Promotion (CHERP). She has over a decade of experience contributing to qualitative, quantitative, and mixed methods studies focused on marginalized communities and the social determinants of health.

Ann Elizabeth Montgomery

Ann Elizabeth Montgomery is an Assistant Professor at the University of Alabama at Birmingham School of Public Health in the Department of Health Behavior as well as an Investigator with the VA National Center on Homelessness Among Veterans (NCHAV) and Birmingham VA Medical Center. Dr. Montgomery's work focuses on homelessness prevention, interventions to end homelessness among high-need Veterans, and the demography, epidemiology, and services utilization of Veterans experiencing homelessness.

John Cashy

John Cashy is a Research Health Science Specialist with CHERP in Pittsburgh and Philadelphia.

Melissa Dichter

Melissa Dichter is an Associate Professor in the School of Social Work at Temple University and serves as Associate Director and Core Investigator at CHERP. Dr. Dichter’s research focuses on individuals’ experiences with, and system responses to, intimate partner violence as well as on identifying and meeting the health and psychosocial needs of women military Veterans and of gender and sexual minority populations.

Thomas Byrne

Thomas Byrne is an Assistant Professor at the Boston University School of Social Work and serves as an investigator for the VA Center for Healthcare Outcomes & Implementation Research (CHOIR) and NCHAV. His research focuses on homelessness, housing, and Veterans.

John R. Blosnich

John R. Blosnich is an Assistant Professor of Social Work in the Suzanne Dworak-Peck School of Social Work at the University of Southern California and an affiliated researcher with CHERP and NCHAV. Dr. Blosnich's research areas of expertise include interpersonal and self-directed violence among lesbian, gay, bisexual, and transgender (LGBT) individuals. His program of health equity research at the VA focuses on LGBT Veterans, with specific attention to suicide prevention and examining ways that patients’ social determinants of health data can be integrated into adaptive health care systems.