Diabetes
Housing insecurity is associated with uncontrolled diabetes among veterans in Veterans Health Administration (VHA) Simin Hua* Simin Hua Rania Kanchi Earle Chambers Giselle Routhier Lorna Thorpe Jay Pendse
Background
Housing insecurity is known to impact health. However, electronic health record systems often lack systematic measures of housing insecurity to identify the health-related conditions of patients with such social needs on a large scale. This study applied a housing insecurity measure using multiple VHA data sources to understand the relationship between housing insecurity and early diabetes management among U.S. veterans.
Method
A total of 833,366 veterans in VHA with newly-diagnosed type 2 diabetes during 2008-2018 were included. Housing status around the time of diabetes diagnosis (+/- 6 months) was classified as (1) housing insecure but not homeless, (2) homeless, or (3) potentially stably housed, based on multiple sources: ICD-9/10 codes, administrative codes, screening questionnaire responses, and use of housing assistance services. We used mixed effect models to obtain odds ratios of reaching target A1c levels (<8%) and of uncontrolled diabetes (A1c>9%) for up to 5 years post-diagnosis, adjusting for demographics, geographic location, comorbidity index, and frequency of clinical visits.
Results
Approximately 2% were documented as experiencing housing insecurity only while 4.6% of veterans were documented as experiencing homelessness around their diabetes diagnosis. During follow-up, veterans experiencing homelessness were less likely to achieve A1c<8% [OR=0.70 (95% CI 0.67-0.73)]. Veterans experiencing homelessness [OR 1.56 (1.50-1.62)] and housing insecurity [OR 1.14 (1.07-1.21)] were more likely to have uncontrolled diabetes compared to stably housed veterans. Associations were stronger in veterans 65+ years old than those under 65, and among Hispanic veterans than Non-Hispanic White veterans.
Conclusion
Housing insecurity and homelessness are associated with worse diabetes control among veterans in VHA. Targeted efforts should be directed to older veterans and non-White veterans to mitigate adverse impact of homelessness on diabetes management.