{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T04:11:11Z","timestamp":1748578271281,"version":"3.41.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Veterans are disproportionately more likely to experience homelessness and unstable housing (HUH) compared with the general population. Cardiovascular disease is the leading cause of death among Veterans experiencing HUH. We aimed to understand whether HUH status among Veterans with preexisting cardiovascular disease was associated with disparities in cardiovascular care access and utilization.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>Retrospective study of all Veterans with preexisting cardiovascular disease between 2017 and 2019 using Veterans Affairs Corporate Data Warehouse and Homeless registry data. Primary outcomes were annual outpatient visits for cardiovascular disease management and visits with cardiovascular disease\u2013related specialists. Secondary outcomes included cardiovascular disease\u2013related procedures and emergency department visits and hospitalizations. HUH status was determined based on response to a screener, diagnostic codes, or use of homelessness services, and outcomes were assessed in the first year HUH status was determined. After applying inverse probability of treatment weighting, negative binomial and logistic regression models were fit to estimate the association between experiencing HUH and the outcomes of interest.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Among 1\u2009357\u2009973 Veterans (mean age, 71.6 [SD=10.6] years; 2.5% female) with preexisting cardiovascular disease, 56\u2005093 were identified as experiencing HUH during the study period. Veterans experiencing HUH had fewer outpatient visits for cardiovascular disease management or with cardiovascular disease\u2013related specialists (4.3% [95% CI, 2.5%\u20136.1%] and 14.1% [95% CI, 12.5%\u201315.8%], respectively) compared with housed Veterans. HUH status was associated with lower rates of receiving certain procedures including coronary artery bypass graft, lower extremity revascularization, and carotid artery stenosis interventions and higher rates of all-cause and cardiovascular emergency department visits and hospitalizations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Veterans with chronic cardiovascular conditions experiencing HUH had lower rates of outpatient visits for cardiovascular disease management and higher rates of emergency department visits and hospitalizations. Given the disproportionate burden of cardiovascular disease in this population, interventions to improve access to cardiovascular care are needed.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.124.010993","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T09:00:34Z","timestamp":1730710834000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Homelessness and Unstable Housing With Cardiovascular Care Utilization Among Veterans"],"prefix":"10.1161","volume":"17","author":[{"given":"Lara J.","family":"Sokoloff","sequence":"first","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine (L.J.S.), University of Pennsylvania, Philadelphia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingyi","family":"Wu","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine (J.W.), University of Pennsylvania, Philadelphia."},{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0879-7694","authenticated-orcid":true,"given":"Lauren A.","family":"Eberly","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Division of Cardiovascular Medicine (L.A.E., A.S.N., H.M.J., T.J.K., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Leonard Davis Institute of Health Economics (L.A.E., A.S.N., H.M.J., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-6423","authenticated-orcid":true,"given":"Ashwin S.","family":"Nathan","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Division of Cardiovascular Medicine (L.A.E., A.S.N., H.M.J., T.J.K., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Leonard Davis Institute of Health Economics (L.A.E., A.S.N., H.M.J., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4130-097X","authenticated-orcid":true,"given":"Howard M.","family":"Julien","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Division of Cardiovascular Medicine (L.A.E., A.S.N., H.M.J., T.J.K., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Leonard Davis Institute of Health Economics (L.A.E., A.S.N., H.M.J., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.)."},{"name":"Merck &amp; Co., Rahway, NJ (H.M.J.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-6225","authenticated-orcid":true,"given":"Taisei J.","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Division of Cardiovascular Medicine (L.A.E., A.S.N., H.M.J., T.J.K., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8009-1632","authenticated-orcid":true,"given":"Scott M.","family":"Damrauer","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Leonard Davis Institute of Health Economics (L.A.E., A.S.N., H.M.J., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Department of Surgery, Perelman School of Medicine (S.M.D.), University of Pennsylvania, Philadelphia."},{"name":"Department of Genetics, Perelman School of Medicine (S.M.D.), University of Pennsylvania, Philadelphia."},{"name":"Penn Cardiovascular Institute, Perelman School of Medicine (S.M.D.), University of Pennsylvania, Philadelphia."},{"name":"Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7374-4292","authenticated-orcid":true,"given":"Peter W.","family":"Groeneveld","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Leonard Davis Institute of Health Economics (L.A.E., A.S.N., H.M.J., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Division of General Internal Medicine, Perelman School of Medicine (P.W.G.), University of Pennsylvania, Philadelphia."},{"name":"Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.)."},{"name":"Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (P.W.G. and S.A.M.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-648X","authenticated-orcid":true,"given":"Jack","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington, DC (J.T.)."},{"name":"School of Public Health, University of Texas Health Science Center at Houston (J.T.)."},{"name":"Department of Psychiatry, Yale University School of Medicine, New Haven, CT (J.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1345-3004","authenticated-orcid":true,"given":"Sameed Ahmed M.","family":"Khatana","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine (J.W., L.A.E., A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Division of Cardiovascular Medicine (L.A.E., A.S.N., H.M.J., T.J.K., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Leonard Davis Institute of Health Economics (L.A.E., A.S.N., H.M.J., S.M.D., P.W.G., S.A.M.K.), University of Pennsylvania, Philadelphia."},{"name":"Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (A.S.N., H.M.J., T.J.K., S.M.D., P.W.G., S.A.M.K.)."},{"name":"Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (P.W.G. and S.A.M.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","article-title":"Veteran homelessness: a supplemental report to the 2009 Annual Homeless Assessment Report to Congress.","author":"Khadduri J","year":"2010","unstructured":"Khadduri J, Culhane D, Cortes A. Veteran homelessness: a supplemental report to the 2009 Annual Homeless Assessment Report to Congress. US Department of Housing and Urban Development & Department of Veterans Affairs. 2010. https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2009AHARVeteransReport.pdf","journal-title":"US Department of Housing and Urban Development & Department of Veterans Affairs"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.510826"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.077"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2010.03.024"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201500095"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1757913920919796"},{"key":"e_1_3_3_8_2","article-title":"The 2020 annual homeless assessment report (AHAR) to congress. Part 1: point-in-time estimates of homelessness.","author":"Henry M","year":"2021","unstructured":"Henry M, de Sousa T, Roddey C, Gayen S, Bednar TJ. The 2020 annual homeless assessment report (AHAR) to congress. Part 1: point-in-time estimates of homelessness. The US Department of Housing and Urban Development. 2021. https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2020-AHAR-Part-1.pdf","journal-title":"The US Department of Housing and Urban Development"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2020.12.012"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.23889\/ijpds.v4i3.1185"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.6010"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.1458"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-129-5-199809010-00012"},{"key":"e_1_3_3_14_2","unstructured":"Department of Veterans Affairs. Eligibility for VA health care. Updated May 15 2024. Accessed May 21 2024. https:\/\/www.va.gov\/health-care\/eligibility\/"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732319829434"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2024.2352293"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2005.077628"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(02)02493-2"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/rssb.12027"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0279973"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132664"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-016-3786-z"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/rssb.12027"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1032017"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooac103"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.92.5.778"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301307"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301369"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-05946-4"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31827da5b9"},{"key":"e_1_3_3_31_2","unstructured":"Department of Veterans Affairs. VHA health care for homeless Veterans fact sheet. https:\/\/www.va.gov\/HOMELESS\/docs\/HCHV-Fact-Sheet-508.pdf"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07970-y"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301632"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000770"},{"key":"e_1_3_3_35_2","article-title":"Estimating cost savings associated with HUD-VASH placement.","author":"Byrne T","year":"2014","unstructured":"Byrne T, Roberts CB, Culhane DP, Kane V. Estimating cost savings associated with HUD-VASH placement. Research Brief, National Center on Homelessness Among Veterans. 2014. https:\/\/www.va.gov\/HOMELESS\/Estimating_Cost_Savings_Associated_With_HUD_VASH_Placement.pdf","journal-title":"Research Brief, National Center on Homelessness Among Veterans"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01041"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13553"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.124.010993","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T21:14:24Z","timestamp":1748553264000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.124.010993"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":36,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.124.010993"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.124.010993","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"type":"print","value":"1941-7713"},{"type":"electronic","value":"1941-7705"}],"subject":[],"published":{"date-parts":[[2024,11]]},"assertion":[{"value":"2024-02-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}