Long-term effects of homelessness on mortality: a 15-year Australian cohort study
Long-term effects of homelessness on mortality: a 15-year Australian cohort study
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DOI：
10.1111/1753-6405.13038
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发表时间：
2020-09-21
影响因子：
3.5
通讯作者：
Sundararajan, Vijaya
中科院分区：
文献类型：
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作者：
Seastres, Ramon Jose;Hutton, Jennie;Sundararajan, Vijaya
目的：探讨无家可归对死亡率的影响。方法：这项为期15年的回顾性纵向队列研究比较了2003年1月1日至2004年12月31日在维多利亚州墨尔本市中心一家公立医院急诊科就诊的无家可归者和非无家可归者的死亡率。无家可归者在招募期间有>= 1次记录的无家可归事件，按类型分类：初级、二级、三级、边缘住房。非无家可归者得到了稳定的住所。结果：15年以上，与非无家可归者相比，无家可归者的死亡率更高（11.89比8.10 / 1000人-年），死亡风险显著增加（比率为1.47,95%置信区间[CI] 1.26-1.71），死亡中位年龄更年轻（66.60比78.19岁）。使用调整后的Cox比例风险模型，初级（风险比[HR] 2.05, 95%CI 1.67-2.50）、次级（风险比[HR] 1.60, 95%CI 1.23-2.10）和三级（风险比[HR] 1.72, 95%CI 1.16-2.56）无家可归是过早死亡的独立危险因素。结论：至少有一次记录的初级、二级或三级无家可归与15年期间的过早死亡率和较年轻的死亡年龄有关。对公共卫生的影响：在急诊科准确识别经历初级、二级或三级无家可归的个人，可能使有针对性的干预措施有可能降低他们过早死亡的风险。
Objective: To examine the effect of homelessness on mortality. Methods: This 15-year retrospective longitudinal cohort study compared mortality outcomes of homeless and non-homeless adults attending the emergency department of an inner-city public hospital in Melbourne, Victoria between 1 January 2003 and 31 December 2004. Homeless individuals had >= 1 recorded episodes of homelessness within the recruitment period, categorised by type: primary, secondary, tertiary, marginally housed. Non-homeless individuals were stably housed throughout. Results: Over 15 years, homeless individuals had a higher mortality rate (11.89 vs. 8.10 per 1,000 person-years), significantly increased mortality risk (rate ratio 1.47, 95% confidence interval [CI] 1.26-1.71) and younger median age at death (66.60 vs. 78.19 years) compared to non-homeless individuals. Using adjusted Cox proportional hazards models, primary (hazard ratio [HR] 2.05, 95%CI 1.67-2.50), secondary (HR 1.60, 95%CI 1.23-2.10) and tertiary (HR 1.72, 95%CI 1.16-2.56) homelessness were independent risk factors for premature mortality. Conclusion: At least one recorded episode of primary, secondary, or tertiary homelessness was associated with premature mortality and younger age at death over a 15-year period. Implications for public health: Accurately identifying individuals experiencing primary, secondary or tertiary homelessness at the emergency department may enable targeted interventions that could potentially reduce their risk of premature mortality.