Ajay Manhapra1, Elina Stefanovics2, Robert Rosenheck2. 1. VA New England Mental Illness Research and Education Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; Pain Medicine Section, Department of Physical Medicine & Rehabilitation, Hampton VA Medical Center, Hampton, VA, United States; Departments of Physical Medicine & Rehabilitation and Psychiatry, Eastern Virginia Medical School, Norfolk, VA, United States. Electronic address: ajay.manhapra@yale.edu. 2. VA New England Mental Illness Research and Education Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
Abstract
BACKGROUND: Substance use disorder (SUD) is a major risk factor for homelessness, but the specific association of opioid use disorder (OUD) and homelessness in the context of their shared risk factors has not been the focus of prior studies. We used national data from the United States Veterans Health Administration (VHA) to examine the association of OUD and homelessness in the context of shared risk factors. METHODS: In this cross-sectional analysis of veterans who received VHA care during Fiscal Year 2012 (N = 5,450,078), we compared the prevalence of OUD and other sociodemographic, and clinical factors among homeless and non-homeless veterans. We estimated the odds ratio for homelessness associated with OUD alone, and after adjusting for other factors through multivariate logistic regression. RESULTS: Homeless veterans had substantially higher prevalence of OUD than other VHA patients (7.7 % Vs 0.6 %) and OUD was associated with 13 times higher unadjusted odds of homelessness (Odds Ratio [OR] 13.36, 95 % CI 13.09-13.62), which decreased with adjustment for sociodemographic factors (black race, mean income and age), other SUD, medical, and psychiatric diagnoses (final OR 1.57, 95 % CI 1.53-1.61). Other SUDs (alcohol, cannabis, cocaine, and hallucinogens) showed similar or slightly higher odds of homelessness as OUD in the final model. CONCLUSIONS: OUD was strongly associated with homelessness among US veterans although this association was largely but not entirely attenuated by shared sociodemographic and co-morbid risk factors including several other SUDs. Treatment of homeless veterans with OUD should address socio-economic vulnerabilities and other co-morbidities in addition to treatments for OUD. Published by Elsevier B.V.
BACKGROUND: Substance use disorder (SUD) is a major risk factor for homelessness, but the specific association of opioid use disorder (OUD) and homelessness in the context of their shared risk factors has not been the focus of prior studies. We used national data from the United States Veterans Health Administration (VHA) to examine the association of OUD and homelessness in the context of shared risk factors. METHODS: In this cross-sectional analysis of veterans who received VHA care during Fiscal Year 2012 (N = 5,450,078), we compared the prevalence of OUD and other sociodemographic, and clinical factors among homeless and non-homeless veterans. We estimated the odds ratio for homelessness associated with OUD alone, and after adjusting for other factors through multivariate logistic regression. RESULTS: Homeless veterans had substantially higher prevalence of OUD than other VHA patients (7.7 % Vs 0.6 %) and OUD was associated with 13 times higher unadjusted odds of homelessness (Odds Ratio [OR] 13.36, 95 % CI 13.09-13.62), which decreased with adjustment for sociodemographic factors (black race, mean income and age), other SUD, medical, and psychiatric diagnoses (final OR 1.57, 95 % CI 1.53-1.61). Other SUDs (alcohol, cannabis, cocaine, and hallucinogens) showed similar or slightly higher odds of homelessness as OUD in the final model. CONCLUSIONS: OUD was strongly associated with homelessness among US veterans although this association was largely but not entirely attenuated by shared sociodemographic and co-morbid risk factors including several other SUDs. Treatment of homeless veterans with OUD should address socio-economic vulnerabilities and other co-morbidities in addition to treatments for OUD. Published by Elsevier B.V.
Entities:
Keywords:
Homelessness; Medical comorbidity; Opioid use disorder; Psychiatric comorbidity; Substance use disorders
Authors: Derjung M Tarn; Kevin J Shih; Allison J Ober; Sarah B Hunter; Katherine E Watkins; Jeremy Martinez; Alanna Montero; Michael McCreary; Isabel Leamon; John Sheehe; Elizabeth Bromley Journal: Community Ment Health J Date: 2022-07-29
Authors: Alex S Bennett; Honoria Guarino; Peter C Britton; Dan O'Brien-Mazza; Stephanie H Cook; Franklin Taveras; Juan Cortez; Luther Elliott Journal: Ann Med Date: 2022-12 Impact factor: 5.348