The association between residential relocation and mortality among Veterans with experience of housing instability in rural areas

Le résumé fourni par la source

PURPOSE: Housing instability deleteriously affects health outcomes (i.e., lack of access to care, premature mortality). Veterans experiencing housing instability in rural areas-which often lack housing options, transportation, and services-have greater odds of residential relocation compared to urban Veterans, and they most frequently relocate to urban areas. Urban relocation is associated with changes in health outcomes, including increased services use, but studies have not examined the association between residential relocation and mortality. METHODS: This study used Veterans Affairs electronic health record data for 28,058 Veterans who experienced housing instability at a rural residence and then, within 2 years, changed their residential location by ≥40 mi or from a rural-to-urban location. We assessed the risk of mortality during the 6 months following residential relocation, controlling for sociodemographics, baseline comorbid health conditions, and time-varying services use. FINDINGS: One-third of the rural Veterans experiencing housing instability had a rural-to-rural relocation (n = 7227), whereas the remaining had a rural-to-urban relocation (n = 17,375). Veterans with a rural-to-rural relocation were older and had more comorbid medical conditions compared to Veterans with rural-to-urban relocation; however, Veterans with a rural-to-urban relocation had 28% greater odds of mortality during the 6 months following residential relocation than Veterans with rural-to-rural relocation. CONCLUSIONS: Rural-to-rural relocation was associated with reduced odds of mortality, even when controlling for services utilization, age, and baseline comorbidities. Future research should explore if and how remaining in rural environments is protective and identify ways to support care coordination following residential relocations among Veterans with experience of housing instability.

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