INTRODUCTION Homelessness adversely affects patient outcomes in broad cohort studies; however, its impact on key liver-related outcomes in patients with cirrhosis is understudied. We aimed to address this knowledge gap using data from the Veterans Health Administration, a cohort disproportionately affected by homelessness. METHODS This was a retrospective cohort study of the Veterans Health Administration patients with incident cirrhosis diagnosis between January 2008 and February 2022. Homeless status was classified at baseline and as time-updating variable during follow-up. Inverse probability treatment weighted Cox regression was performed to evaluate the association between homelessness and outcomes of all-cause mortality, cirrhosis decompensation, and hepatocellular carcinoma. RESULTS A total of 117,698 patients were included in the cohort, of whom 14,243 (12.1%) were homeless at baseline. In inverse probability treatment weighted Cox regression, homelessness was associated with a 24% higher hazard of all-cause mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.22-1.26, P < 0.001). However, in competing risk regression models, homelessness was associated with a reduced subhazard of decompensation (subhazard ratio 0.86, 95% CI 0.84-0.88, P < 0.001) and hepatocellular carcinoma (subhazard ratio 0.86, 95% CI 0.83-0.89, P < 0.001). In cause-specific mortality analysis, homeless patients had significantly increased non-liver-related and liver-related mortality; however, the magnitude of effect size was greater for non-liver-related mortality (csHR 1.38, 95% CI 1.35-1.40, P < 0.001). DISCUSSION Homelessness in veterans with cirrhosis is associated with increased all-cause mortality; however, this is likely mediated primarily through non-liver-related factors. Future studies are needed to explore drivers of mortality and improve mitigation strategies in these patients.

中文翻译：

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无家可归与肝硬化退伍军人的主要肝脏相关结果之间的关联。

简介 在广泛的队列研究中，无家可归对患者的治疗结果产生不利影响；然而，其对肝硬化患者关键肝脏相关结局的影响尚未得到充分研究。我们的目标是利用退伍军人健康管理局的数据来解决这一知识差距，退伍军人健康管理局是一个受无家可归者影响尤为严重的群体。方法 这是一项对 2008 年 1 月至 2022 年 2 月期间被诊断为肝硬化的退伍军人健康管理局患者进行的回顾性队列研究。无家可归状况在基线时进行分类，并在随访期间作为时间更新变量。采用逆概率处理加权 Cox 回归来评估无家可归与全因死亡率、肝硬化失代偿和肝细胞癌结果之间的关联。结果 该队列共有 117,698 名患者，其中 14,243 名（12.1%）在基线时无家可归。在逆概率处理加权 Cox 回归中，无家可归与全因死亡率高 24% 的风险相关（风险比 [HR] 1.24，95% 置信区间 [CI] 1.22-1.26，P < 0.001）。然而，在竞争风险回归模型中，无家可归与失代偿亚危险（亚危险比 0.86，95% CI 0.84-0.88，P < 0.001）和肝细胞癌（亚危险比 0.86，95% CI 0.83-0.89，P < 0.001）减少相关。 0.001）。在具体原因死亡率分析中，无家可归患者的非肝脏相关和肝脏相关死亡率显着增加；然而，非肝脏相关死亡率的效应大小更大（csHR 1.38，95% CI 1.35-1.40，P < 0.001）。讨论 患有肝硬化的退伍军人无家可归与全因死亡率增加有关；然而，这可能主要是通过非肝脏相关因素介导的。未来的研究需要探索死亡率的驱动因素并改进这些患者的缓解策略。