Increased risks seen for end-stage kidney disease, death, which were attenuated after further adjustment for confounders
By Elana Gotkine HealthDay Reporter
FRIDAY, Sept. 20, 2024 (HealthDay News) — 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 percent were aged 65 to 74 years and 75 to 84 years, respectively.
The researchers found that 3.1 percent of the veterans developed ESKD and 43.0 percent 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 percent confidence interval [CI], 1.10 to 1.20). They also had a greater risk for all-cause death (aHR, 1.48; 95 percent CI, 1.46 to 1.50). The results were attenuated but remained significant for all-cause death (aHR, 1.09; 95 percent 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 percent 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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