Permanent Supportive Housing and Cardiovascular Outcomes Among Veterans Experiencing Homelessness: A Difference-in-Differences Analysis

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BACKGROUND: Veterans experiencing homelessness have a high burden of cardiovascular disease (CVD). Identifying approaches that can improve the health of this population is crucial. OBJECTIVE: The Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) provides permanent supportive housing (PSH) assistance. We examined whether obtaining PSH through HUD-VASH was associated with changes in outcomes among Veterans with CVD experiencing homelessness. DESIGN: Using a difference-in-differences (DID) approach, outcomes among Veterans who received a HUD-VASH voucher and moved into PSH within one month (early group) were compared with those who received a voucher but remained unhoused for at least six months (delayed group). PARTICIPANTS: Veterans ≥ 18 years of age with CVD (coronary artery disease, heart failure, peripheral arterial disease, ischemic stroke/cerebrovascular disease, or atrial fibrillation) who experienced ≥ 6 months of homelessness and received a HUD-VASH voucher in 2016 to 2019. INTERVENTION: Entering PSH after receiving a HUD-VASH voucher. MAIN MEASURES: Six-month probability of a cardiovascular ED visit or hospitalization. KEY RESULTS: Among 970 Veterans with CVD experiencing homelessness, 845 were in the early and 125 in the delayed PSH group. There was a significant decrease in the 6-month probability of cardiovascular ED visits or hospitalizations (16.3% [95% CI 13.9% - 18.7%] to 11.9% [95% CI 9.8% - 14.0%]) among Veterans who received a voucher and moved into PSH within one month, but no statistically significant change among Veterans who did not move into PSH for at least 6 months (13.4% [95% CI 8.0% - 18.8%] to 18.1% [95% CI 11.4% - 24.8%]) for a DID estimate of -9.1 (95% CI -17.7 - -0.5) percentage points, p = 0.04. CONCLUSIONS: Obtaining PSH through HUD-VASH was associated with a significant decrease in the probability of CVD related ED visits or hospitalizations among Veterans with chronic CVD experiencing homelessness.

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