{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:23:07Z","timestamp":1786425787413,"version":"build-2736575974"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T00:00:00Z","timestamp":1718236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Homelessness and housing instability disproportionately affect U.S. veterans with psychiatric disorders, human immunodeficiency virus\/acquired immunodeficiency syndrome (HIV\/AIDS), hepatitis C, and Alzheimer\u2019s disease and related disorders (ADRD). We examined housing status and\/or HIV\/AIDS in relation to ADRD risk and evaluated hepatitis C, substance use, and mental health disorders as mediators and\/or moderators of hypothesized relationships, among U.S. veterans \u226550 years of age seeking Department of Veterans Affairs (VA) healthcare services.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective cohort study was conducted using linked VA Homeless Operations Management and Evaluation System and Corporate Data Warehouse databases (2017\u20132023) on 3\u2005275\u2009098 eligible veterans yielding 133\u2009388 ADRD cases over 5 years of follow-up. Multivariable regression and causal mediation analyses were performed, controlling for demographic and clinical characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Taking stably housed veterans without HIV\/AIDS as referent, ADRD risk was higher among veterans with homelessness\/housing instability alone (adjusted hazard ratio [aHR]\u2005=\u20051.67, 95% confidence interval [CI]: 1.63,1.72), lower among veterans with HIV\/AIDS alone (aHR\u2005=\u20050.65, 95% CI: 0.58,0.73), but similar to veterans with homelessness\/housing instability and HIV\/AIDS (aHR\u2005=\u20051.01, 95% CI: 0.79,1.29). In adjusted models, hepatitis C and psychiatric disorders were positively related to homelessness\/housing instability and ADRD risk, but negatively related to HIV\/AIDS. Statistically significant mediation and\/or moderation of hepatitis C and psychiatric disorders were observed, although &amp;lt;10% of total effects were explained by these characteristics, controlling for confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among older veterans, ADRD diagnoses over 5 years were less among those with HIV\/AIDS, but more among those with homelessness\/housing instability, and these relationships were partly explained by hepatitis C and psychiatric disorders.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/gerona\/glae153","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T10:40:44Z","timestamp":1718361644000},"source":"Crossref","is-referenced-by-count":9,"title":["Is the Risk of Alzheimer\u2019s Disease and Related Dementias Among U.S. Veterans Influenced by the Intersectionality of Housing Status, HIV\/AIDS, Hepatitis C, and Psychiatric Disorders?"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9704-328X","authenticated-orcid":false,"given":"Hind A","family":"Beydoun","sequence":"first","affiliation":[{"name":"VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs , Washington, District of Columba ,","place":["USA"]},{"name":"Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston , Houston, Texas,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Szymkowiak","sequence":"additional","affiliation":[{"name":"VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs , Washington, District of Columba ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Kinney","sequence":"additional","affiliation":[{"name":"VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs , Washington, District of Columba ,","place":["USA"]},{"name":"Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-4523","authenticated-orcid":false,"given":"May A","family":"Beydoun","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan B","family":"Zonderman","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Tsai","sequence":"additional","affiliation":[{"name":"VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs , Washington, District of Columba ,","place":["USA"]},{"name":"Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"issue":"9503","key":"2024102906175317500_CIT0001","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1016\/S0140-6736(05)67889-0","article-title":"Global prevalence of dementia: a Delphi consensus study","volume":"366","author":"Ferri","year":"2005","journal-title":"Lancet."},{"issue":"1","key":"2024102906175317500_CIT0002","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jalz.2012.11.007","article-title":"The global prevalence of dementia: a systematic review and metaanalysis","volume":"9","author":"Prince","year":"2013","journal-title":"Alzheimers Dement"},{"issue":"8","key":"2024102906175317500_CIT0003","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.arcmed.2012.11.003","article-title":"Epidemiology of dementias and Alzheimer\u2019s disease","volume":"43","author":"Sosa-Ortiz","year":"2012","journal-title":"Arch Med Res."},{"issue":"3","key":"2024102906175317500_CIT0004","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1051\/medsci\/2006223288","article-title":"[Epidemiology of Alzheimer disease and related disorders]","volume":"22","author":"Helmer","year":"2006","journal-title":"Med Sci (Paris)"},{"issue":"1","key":"2024102906175317500_CIT0005","doi-asserted-by":"crossref","first-page":"igz043","DOI":"10.1093\/geroni\/igz043","article-title":"The public health road map to respond to the growing dementia crisis","volume":"4","author":"Olivari","year":"2020","journal-title":"Innov. 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