{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T16:46:31Z","timestamp":1769013991328,"version":"3.49.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Adults experiencing homelessness in the US face numerous challenges, including the management of chronic kidney disease (CKD). The extent of a potentially greater risk of adverse health outcomes in the population with CKD experiencing homelessness has not been adequately explored.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the association between a history of homelessness and the risk of end-stage kidney disease (ESKD) and death among veterans with incident CKD.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study was conducted between January 1, 2005, and December 31, 2017. Participants included veterans aged 18 years and older with incident stage 3 to 5 CKD utilizing the Veterans Health Administration health care network in the US. Patients were followed-up through December 31, 2018, for the occurrence of ESKD and death. Analyses were performed from September 2022 to October 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>History of homelessness, based on utilization of homeless services in the Veterans Health Administration or International Classification of Diseases, Ninth Revision<\/jats:italic> or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision<\/jats:italic> codes. Homelessness was measured during the 2-year baseline period prior to the index date of incident CKD.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were ESKD, based on initiation of kidney replacement therapy, and all-cause death. Adjusted hazard ratios (HRs) were calculated to compare veterans with a history of homelessness with those without a history of homelessness.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 836\u202f361 veterans, the largest proportion were aged 65 to 74 years (274\u202f371 veterans [32.8%]) or 75 to 84 years (270\u202f890 veterans [32.4%]), and 809\u202f584 (96.8%) were male. A total of 26\u202f037 veterans (3.1%) developed ESKD, and 359\u202f991 (43.0%) died. Compared with veterans who had not experienced homelessness, those with a history of homelessness showed a significantly greater risk of ESKD (adjusted HR, 1.15; 95% CI, 1.10-1.20). A greater risk of all-cause death was also observed (HR, 1.48; 95% CI, 1.46-1.50). After further adjustment for body mass index, comorbidities, and medication use, results were attenuated for all-cause death (HR, 1.09; 95% CI, 1.07-1.11) and were no longer significant for ESKD (HR, 1.04; 95% CI, 0.99-1.09).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of veterans with incident stage 3 to 5 CKD, a history of homelessness was significantly associated with a greater risk of ESKD and death, underscoring the role of housing as a social determinant of health.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.31973","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T15:01:03Z","timestamp":1725980463000},"page":"e2431973","source":"Crossref","is-referenced-by-count":4,"title":["Homelessness and Risk of End-Stage Kidney Disease and Death in Veterans With Chronic Kidney Disease"],"prefix":"10.1001","volume":"7","author":[{"given":"Alain 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