Residential migration among Veterans with experience of housing instability

Abstract: Housing instability is an important determinant of health and can lead to reduced life expectancy as well as other poor outcomes. While homelessness is often perceived as an urban phenomenon, it is also present in rural areas of the U.S. Compared with non-Veterans, Veterans are more likely both to be living in rural areas and experiencing housing instability. The U.S. Department of Veterans Affairs (VA) offers health care and social services—including a variety of responses to housing instability—in facilities across the U.S. The objective of the present study is to estimate the frequency of migration among Veterans with experience of homelessness, the characteristics of their migrations, and individual and community-level characteristics that may predict their migrations. We used VA administrative data for 559,513 Veterans with an indicator of housing instability between January 1, 2014, and December 31, 2018, with up to a 5-year observation period. The primary outcome of interest was migration, defined as a single geographic residential relocation (i.e., a change of residential address) of more than 40 miles or a geographic residential relocation of fewer than 40 miles but with a change in urban/rural status. Controlling for a variety of covariates, we utilized a discrete-time survival framework with person-quarter as the unit of analysis; this allowed us to directly model event rates over time with the inclusion of time-varying predictors. Across the observation period, about one-quarter of Veterans with an indicator of housing instability migrated, most frequently those who resided in a rural area and sought care at an urban facility; the majority migrated to or within an urban area and these migrations were of a greater distance than migrations to or within a rural area. Future work in this area should focus on investigating differences in findings across geographic regions, Veterans' reasons for migration, and the impact of migration on Veterans’ health and housing outcomes.

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