Homelessness, Unsheltered Status, and Risk Factors for Mortality
Homelessness, Unsheltered Status, and Risk Factors for Mortality
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无家可归、无家可归的状况和死亡的风险因素
DOI：
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发表时间：
2016
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影响因子：
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通讯作者：
D. Culhane
中科院分区：
文献类型：
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作者：
A. Montgomery;Dorota Szymkowiak;J. Marcus;P. Howard;D. Culhane
目标：与住在收容所的人相比，露宿街头的人往往健康状况较差，获得保健的机会较少，过早死亡的风险也更高。本研究的目的是：(1)比较主要在无庇护情况下睡觉的无家可归者与在无家可归者收容所和其他庇护情况下睡觉的无家可归者的特征；(2)确定无庇护状态的相关性；(3)评估无庇护状态与死亡风险增加之间的关系。方法：使用作为100,000 Homes运动（一项帮助社区为弱势群体和长期无家可归的美国人寻找住所的全国性努力）的一部分收集的原始数据，我们估计了2种广义线性混合模型，以了解无住所状态和死亡率风险因素的相关性。自变量包括人口统计学特征；无家可归、监禁、寄养、精神疾病或药物使用治疗史；收入来源；过去和现在的健康状况研究样本包括25489名无家可归者，作为2008年至2014年10万住房运动的一部分，他们对住房和健康评估做出了回应。结果：在完整模型中，以下特征与无庇护状态相关：退伍军人（调整优势比[aOR] = 1.10）；5年)、监禁（aOR = 1.32）或物质使用（曾经滥用药物或酒精的aOR = 1.10，曾经静脉注射药物的aOR = 1.13，过去一个月每天饮酒的aOR = 1.98）。无庇护（aOR = 1.12）、女性（aOR = 1.22）或领取津贴（aOR = 1.63）增加了受访者具有死亡危险因素的几率。结论：这些发现突出表明，有必要积极地接触弱势群体，并在他们过渡期间提供干预措施，以帮助他们——例如，当他们走出监禁或因年龄增长而离开寄养中心时。这种对策可以防止无家可归，从而解决死亡风险增加的问题。尤其重要的是将人们与资源联系起来，以增加他们获得就业、福利和其他收入来源的机会。
Objectives: People who live in unsheltered situations, such as the streets, often have poorer health, less access to health care, and an increased risk of premature mortality as compared with their sheltered counterparts. The objectives of this study were to (1) compare the characteristics of people experiencing homelessness who were sleeping primarily in unsheltered situations with those who were accessing homeless shelters and other sheltered situations, (2) identify correlates of unsheltered status, and (3) assess the relationship between unsheltered status and increased risk of mortality. Methods: Using primary data collected as part of the 100 000 Homes Campaign—a national effort to help communities find homes for vulnerable and chronically homeless Americans—we estimated 2 generalized linear mixed models to understand the correlates of unsheltered status and risk factors for mortality. Independent variables included demographic characteristics; history of homelessness, incarceration, foster care, and treatment for mental illness or substance use; sources of income; and past and present medical conditions. The study sample comprised 25489 people experiencing homelessness who responded to an assessment of their housing and health as part of the 100 000 Homes Campaign from 2008 to 2014. Results: In the full model, the following characteristics were associated with unsheltered status: being a veteran (adjusted odds ratio [aOR] = 1.10); having 5 years), incarceration (aOR = 1.32), or substance use (aOR = 1.10 for ever abusing drugs or alcohol, aOR = 1.13 for ever using intravenous drugs, aOR = 1.98 for drinking alcohol every day for past month). Being unsheltered (aOR = 1.12), being female (aOR = 1.22), or receiving entitlements (aOR = 1.63) increased respondents’ odds of having risk factors for mortality. Conclusions: These findings highlight the need to assertively reach out to vulnerable populations and provide interventions to assist them during their transition—for example, as they exit incarceration or age out of foster care. Such a response could prevent unsheltered homelessness and thereby address increased mortality risk. Connecting people with resources to increase their access to employment, benefits, and other sources of income is especially important.