Predictors of recurrent stroke and subsequent mortality among patients experiencing housing instability.

Autor: Montgomery AE; Departments of Health Behavior, The University of Alabama at Birmingham, Birmingham, AL 35294, United States; Birmingham VA Medical Center, Birmingham, AL, United States., DeRussy AJ; Birmingham VA Medical Center, Birmingham, AL, United States., Richman JS; Departments of Surgery, The University of Alabama at Birmingham, Birmingham, AL 35294, United States; Birmingham VA Medical Center, Birmingham, AL, United States., Lin C; Departments of Neurology, The University of Alabama at Birmingham, Birmingham, AL 35294, United States; Birmingham VA Medical Center, Birmingham, AL, United States. Electronic address: clin@uabmc.edu.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2024 Sep; Vol. 33 (9), pp. 107896. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107896
Abstrakt: Background: The experience of homelessness has been linked with developing poor health outcomes. Little is known about the risk of recurrent stroke among these individuals. This study investigated the correlates of developing recurrent stroke and subsequent mortality among Veterans with housing instability.
Methods: Using a national sample of Veterans from the U.S. Department of Veterans Affairs who had an indicator of housing instability between 2014-2018 (n=659,987), we identified 15,566 Veterans who experienced incident stroke. We compared characteristics of Veterans who experienced incident stroke and did and did not experience recurrent stroke and conducted logistic regressions using a discrete-time survival framework to assess two outcomes: recurrent stroke and all-cause mortality.
Results: Among our cohort, 91.3% did not experience recurrent stroke while 8.7% did during the observation period. The receipt of any level of primary care outpatient visits was associated with a reduction in the odds of recurrent stroke. Several medical diagnoses were also associated with increased odds of recurrent stroke, including hypertension (aOR 1.35, 95% CI 1.15-1.59), diabetes (aOR 1.21, 95% CI 1.07-1.36), and renal disease (aOR 1.17, 95% CI 1.02, 1.35). Veterans who used any level of VA Homeless Programs had reduced odds of all-cause mortality (high level: aOR 0.65, 95% CI 0.60-0.71; low level: aOR 0.66, 95% CI 0.60-0.73).
Conclusion: Our study found several predictors of developing recurrent stroke and subsequent death in a population of Veterans experiencing housing instability. Implications include the need to monitor closely high-risk patients who have experienced incident stroke and have other co-occurring needs.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Chen Lin reports financial support was provided by US Department of Veterans Affairs. Ann E Montgomery, Aerin DeRussy, Joshua Richman reports financial support was provided by US Department of Veterans Affairs. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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