Hepatitis C Morbidity, Mortality Risk Reduced in Homeless Patients Through Supportive Housing

A permanent supportive housing (PSH) program was associated with significantly reduced risk of liver-related morbidity and mortality among patients with hepatitis C virus infection (HCV) and chronic homelessness, according to study findings published recently in The Journal of Infectious Diseases.

HCV infection has been shown to disproportionately affect people experiencing homelessness, which exposes these patient populations to increased risk of virus-associated sequelae such as liver disease, liver cancer, and premature mortality. HCV infection may also be an important predictor for emergency department (ED) use among persons experiencing homelessness, noted researchers.

“PSH is an intervention that provides both housing and supportive services to persons with complex medical histories who are chronically homeless or at risk of homelessness,” they explained. “It has been shown to not only improve housing stability but also to improve health outcomes and reduce the utilization of shelters and ED visits and the frequency of incarceration.”

Patient record data was derived from the New York/New York III (NYNYIII) large-scale supportive housing program, which provides subsidized, permanent housing along with supportive social services and connections to health care for people experiencing chronic homelessness, defined as those with a history of living on the streets or in a shelter for 2 of the past 4 years or someone living with a disability, 12 of the past 24 months.

The study authors matched records for persons eligible for the New York City PSH program (2007–2014) with Heath Department HCV and Vital Statistics registries and Medicaid claims to firstly assess prevalence of the virus in these populations. They then evaluated whether placement into the PSH program was associated with a reduction in liver-related ED visits, hospitalizations, and deaths among persons with HCV infection.

People who were “placed” in the program were those who were housed in a NYNYIII unit for 8 or more days, whereas “unplaced” individuals were those who were eligible for NYNYIII housing but either not placed into a unit within the program or placed for 7 or less days, and they were also not placed into another supportive housing program within 6 months of their NYNYIII eligibility date.

“Among persons diagnosed with HCV before or 2 years posteligibility, we added stabilized inverse probability of treatment weights to negative binomial regression models to compare rates for liver disease-related ED visits and hospitalizations, and hazard ratios for mortality, by program placement 2 and 5 years posteligibility.”

A total of 1158 of 8783 placed and 1952 of 19,019 unplaced persons with laboratory-confirmed HCV infection were included in the study. Baby boomers (born between 1945 and 1965) comprised of 77% (placed) and 70% (unplaced) of infected persons (P < .001), the proportion of individuals with comorbid HIV/AIDS was 34% among placed and 22% among unplaced persons (P < .001), and 80% of placed persons and 76% of unplaced persons had an substance abuse disorder (P < .001).

Findings showed that PSH placement was associated with significantly reduced liver-related ED visits (adjusted rate ratio [aRR], 0.76; 95% CI, 0.61-0.95), hospitalizations (aRR, 0.62, 95% CI, 0.54-0.71), and end-stage liver disease hospitalizations (aRR, 0.31, 95% CI, 0.20-0.49).  Significant decreases were also observed among placed vs unplaced individuals for all-cause (adjusted HR [aHR], 0.65; 95% CI, 0.46-0.92) and liver-related mortality (aHR, 0.72; 95% CI, 0.09-0.83) within 2 years after the first program eligibility. The reduction remained significant for hospitalizations after 5 years.

“Our findings provide important evidence that supportive housing programs should be expanded to help address HCV infection and poor liver-related health among persons experiencing homelessness,” concluded researchers.

Reference

Miller-Archie SA, Walters SC, Bocour A, et al. The impact of supportive housing on liver-related outcomes among persons with hepatitis C virus infection. J Infect Dis. 2022 Oct 7;226(Supplement_3):S363-S371. doi:10.1093/infdis/jiac292