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Public Health Rep. 2019 Mar/Apr;134(2):126-131. doi: 10.1177/0033354918821071. Epub 2019 Jan 30.

A Novel Measure to Assess Variation in Hepatitis C Prevalence Among Homeless and Unstably Housed Veterans, 2011-2016.

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1 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
2 Boston University School of Social Work, Boston MA, USA.
3 Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University, Palo Alto, CA, USA.
4 Departments of Medicine, and Health Law, Policy, and Management, Boston University Schools of Medicine and Public Health, Boston, MA, USA.
5 Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Boston MA, USA.


We constructed a novel measure of homelessness to examine differences in hepatitis C virus (HCV) prevalence across 3 categories of unstably housed and homeless veterans and across US Department of Veterans Affairs Medical Center facilities. We used Veterans Affairs administrative data to classify a cohort of 434 240 veterans as at risk of homelessness, currently homeless, or formerly homeless, and we examined variation in HCV prevalence by using descriptive measures and mixed-effect logistic regression models. HCV prevalence was highest among veterans who were formerly homeless (16.7%; 32 490 of 195 000), followed by currently homeless (12.4%; 22 050 of 178 056) and at risk of homelessness (8.2%; 5015 of 61 184). Veterans Affairs Medical Center-level prevalence ranged from 5.4% to 21.5%. Differences in HCV prevalence were significant by sex, race/ethnicity, and age. Targeting specific populations of homeless veterans for tailored HCV interventions and allocating additional resources to certain Veterans Affairs Medical Centers may be warranted.


health care delivery; hepatitis; homelessness; housing; veterans’ health


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