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Background <p>Veterans experiencing homelessness have a high burden of cardiovascular disease (CVD). Identifying approaches that can improve the health of this population is crucial.</p> Objective <p>The Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) provides permanent supportive housing (PSH) assistance. We examined whether obtaining PSH through HUD-VASH was associated with changes in outcomes among Veterans with CVD experiencing homelessness.</p> Design <p>Using a difference-in-differences (DID) approach, outcomes among Veterans who received a HUD-VASH voucher and moved into PSH within one month (early group) were compared with those who received a voucher but remained unhoused for at least six months (delayed group).</p> Participants <p>Veterans ≥ 18&#xa0;years of age with CVD (coronary artery disease, heart failure, peripheral arterial disease, ischemic stroke/cerebrovascular disease, or atrial fibrillation) who experienced ≥ 6&#xa0;months of homelessness and received a HUD-VASH voucher in 2016 to 2019.</p> Intervention <p>Entering PSH after receiving a HUD-VASH voucher.</p> Main Measures <p>Six-month probability of a cardiovascular ED visit or hospitalization.</p> Key Results <p>Among 970 Veterans with CVD experiencing homelessness, 845 were in the early and 125 in the delayed PSH group. There was a significant decrease in the 6-month probability of cardiovascular ED visits or hospitalizations (16.3% [95% CI 13.9% – 18.7%] to 11.9% [95% CI 9.8% – 14.0%]) among Veterans who received a voucher and moved into PSH within one month, but no statistically significant change among Veterans who did not move into PSH for at least 6&#xa0;months (13.4% [95% CI 8.0% – 18.8%] to 18.1% [95% CI 11.4% – 24.8%]) for a DID estimate of -9.1 (95% CI -17.7 – -0.5) percentage points, <i>p</i> = 0.04.</p> Conclusions <p>Obtaining PSH through HUD-VASH was associated with a significant decrease in the probability of CVD related ED visits or hospitalizations among Veterans with chronic CVD experiencing homelessness.</p>

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Permanent Supportive Housing and Cardiovascular Outcomes Among Veterans Experiencing Homelessness: A Difference-in-Differences Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月6日

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  • Sameed Ahmed M. Khatana,
  • Jingyi Wu,
  • Peter W. Groeneveld,
  • Vincent J. Reina,
  • Jack Tsai,
  • Eric T. Roberts

摘要

Background

Veterans experiencing homelessness have a high burden of cardiovascular disease (CVD). Identifying approaches that can improve the health of this population is crucial.

Objective

The Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) provides permanent supportive housing (PSH) assistance. We examined whether obtaining PSH through HUD-VASH was associated with changes in outcomes among Veterans with CVD experiencing homelessness.

Design

Using a difference-in-differences (DID) approach, outcomes among Veterans who received a HUD-VASH voucher and moved into PSH within one month (early group) were compared with those who received a voucher but remained unhoused for at least six months (delayed group).

Participants

Veterans ≥ 18 years of age with CVD (coronary artery disease, heart failure, peripheral arterial disease, ischemic stroke/cerebrovascular disease, or atrial fibrillation) who experienced ≥ 6 months of homelessness and received a HUD-VASH voucher in 2016 to 2019.

Intervention

Entering PSH after receiving a HUD-VASH voucher.

Main Measures

Six-month probability of a cardiovascular ED visit or hospitalization.

Key Results

Among 970 Veterans with CVD experiencing homelessness, 845 were in the early and 125 in the delayed PSH group. There was a significant decrease in the 6-month probability of cardiovascular ED visits or hospitalizations (16.3% [95% CI 13.9% – 18.7%] to 11.9% [95% CI 9.8% – 14.0%]) among Veterans who received a voucher and moved into PSH within one month, but no statistically significant change among Veterans who did not move into PSH for at least 6 months (13.4% [95% CI 8.0% – 18.8%] to 18.1% [95% CI 11.4% – 24.8%]) for a DID estimate of -9.1 (95% CI -17.7 – -0.5) percentage points, p = 0.04.

Conclusions

Obtaining PSH through HUD-VASH was associated with a significant decrease in the probability of CVD related ED visits or hospitalizations among Veterans with chronic CVD experiencing homelessness.