Mortality Among Unsheltered Homeless Adults in Boston, Massachusetts, 2000-2009
Mortality Among Unsheltered Homeless Adults in Boston, Massachusetts, 2000-2009
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DOI：
10.1001/jamainternmed.2018.2924
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发表时间：
2018-09-01
影响因子：
39
通讯作者：
Sorensen, Glorian
中科院分区：
文献类型：
--
作者：
Roncarati, Jill S.;Baggett, Travis P.;Sorensen, Glorian
重要性以前的研究表明，无家可归者的死亡率普遍较高，但对“露宿者”的死亡模式知之甚少，“露宿者”是指没有庇护的城市无家可归者，他们避开紧急避难所，主要睡在外面。和参与者一项为期10年的前瞻性队列研究（2000-2009年），研究对象为马萨诸塞州波士顿市的445名无家可归的成年人，他们在2000年期间由波士顿无家可归者计划的街道小组进行的白天街道和夜间货车临床访问中被发现。用于描述无庇护的无家可归者队列和记录死亡原因的数据收集自临床遭遇、医疗记录。国家死亡指数和马萨诸塞州公共卫生部的死亡发生档案。通过使用概率记录链接程序将研究数据集链接到死亡发生率文件，以确认死亡。数据分析从2015年5月1日至2016年9月6日进行。暴露在城市环境中无庇护。主要结局和指标使用2个对照组计算无庇护成人队列的标准化全因和特定原因死亡率和年龄分层发病率比：非无家可归的马萨诸塞州成年人口和来自波士顿的主要睡在庇护所的成年无家可归者队列。结果在研究队列中的445名无庇护的成年人中，入组时的平均（SD）年龄为44（11.4）岁，299名参与者（67.2%）为非西班牙裔白色人，72.4%为男性。在死亡的134人中，死亡时的平均（SD）年龄为53（11.4）岁。无庇护队列的全因死亡率几乎是马萨诸塞州人群的10倍（标准化死亡率，9.8; 95%CI，8.2-11.5），是成年无家可归者队列的近3倍（标准化死亡率，2.7; 95%CI，2.3-3.2）。与非西班牙裔白色个体相比，非西班牙裔黑人个体的死亡率超过一半，率比为0.4（95% CI，0.2-0.7; P < .001）。最常见的死亡原因是非传染性疾病（如癌症和心脏病），酒精使用障碍，慢性肝病。结论和相关性死亡率为无家可归的成年人在这项研究中高于马萨诸塞州的成年人口和庇护的成年无家可归者队列同等服务。这项研究表明，这一独特的无家可归者亚群值得特别关注，以满足他们独特的临床和心理社会需求。
IMPORTANCE Previous studies have shown high mortality rates among homeless people in general, but little is known about the patterns of mortality among "rough sleepers," the subgroup of unsheltered urban homeless people who avoid emergency shelters and primarily sleep outside.OBJECTIVES To assess the mortality rates and causes of death for a cohort of unsheltered homeless adults from Boston, Massachusetts.DESIGN, SETTING, AND PARTICIPANTS A 10-year prospective cohort study (2000-2009) of 445 unsheltered homeless adults in Boston, Massachusetts, who were seen during daytime street and overnight van clinical visits performed by the Boston Health Care for the Homeless Program's Street Team during 2000. Data used to describe the unsheltered homeless cohort and to document causes of death were gathered from clinical encounters, medical records. the National Death Index, and the Massachusetts Department of Public Health death occurrence files. The study data set was linked to the death occurrence files by using a probabilistic record linkage program to confirm the deaths. Data analysis was performed from May 1, 2015, to September 6, 2016.EXPOSURE Being unsheltered in an urban setting.MAIN OUTCOMES AND MEASURES Age-standardized all-cause and cause-specific mortality rates and age-stratified incident rate ratios that were calculated for the unsheltered adult cohort using 2 comparison groups: the nonhomeless Massachusetts adult population and an adult homeless cohort from Boston who slept primarily in shelters.RESULTS Of 445 unsheltered adults in the study cohort, the mean (SD) age at enrollment was 44 (11.4) years, 299 participants (67.2%) were non-Hispanic white, and 72.4% were men. Among the 134 individuals who died, the mean (SD) age at death was 53 (11.4) years. The all-cause mortality rate for the unsheltered cohort was almost 10 times higher than that of the Massachusetts population (standardized mortality rate, 9.8; 95% CI, 8.2-11.5) and nearly 3 times higher than that of the adult homeless cohort (standardized mortality rate, 2.7; 95% CI, 2.3-3.2). Non-Hispanic black individuals had more than half the rate of death compared with non-Hispanic white individuals, with a rate ratio of 0.4 (95% CI, 0.2-0.7; P < .001). The most common causes of death were noncommunicable diseases (eg, cancer and heart disease), alcohol use disorder, and chronic liver disease.CONCLUSIONS AND RELEVANCE Mortality rates for unsheltered homeless adults in this study were higher than those for the Massachusetts adult population and a sheltered adult homeless cohort with equivalent services. This study suggests that this distinct subpopulation of homeless people merits special attention to meet their unique clinical and psychosocial needs.