Document Detail

Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period.
MedLine Citation:
PMID:  23318302     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Homeless persons experience excess mortality, but US-based studies on this topic are outdated or lack information about causes of death. To our knowledge, no studies have examined shifts in causes of death for this population over time.
METHODS: We assessed all-cause and cause-specific mortality rates in a cohort of 28 033 adults 18 years or older who were seen at Boston Health Care for the Homeless Program from January 1, 2003, through December 31, 2008. Deaths were identified through probabilistic linkage to the Massachusetts death occurrence files. We compared mortality rates in this cohort with rates in the 2003-2008 Massachusetts population and a 1988-1993 cohort of homeless adults in Boston using standardized rate ratios with 95% confidence intervals.
RESULTS: A total of 1302 deaths occurred during 90 450 person-years of observation. Drug overdose (n = 219), cancer (n = 206), and heart disease (n = 203) were the major causes of death. Drug overdose accounted for one-third of deaths among adults younger than 45 years. Opioids were implicated in 81% of overdose deaths. Mortality rates were higher among whites than nonwhites. Compared with Massachusetts adults, mortality disparities were most pronounced among younger individuals, with rates about 9-fold higher in 25- to 44-year-olds and 4.5-fold higher in 45- to 64-year-olds. In comparison with 1988-1993 rates, reductions in deaths from human immunodeficiency virus (HIV) were offset by 3- and 2-fold increases in deaths owing to drug overdose and psychoactive substance use disorders, resulting in no significant difference in overall mortality.
CONCLUSIONS: The all-cause mortality rate among homeless adults in Boston remains high and unchanged since 1988 to 1993 despite a major interim expansion in clinical services. Drug overdose has replaced HIV as the emerging epidemic. Interventions to reduce mortality in this population should include behavioral health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness.
Travis P Baggett; Stephen W Hwang; James J O'Connell; Bianca C Porneala; Erin J Stringfellow; E John Orav; Daniel E Singer; Nancy A Rigotti
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-12     Completed Date:  2013-04-08     Revised Date:  2014-02-13    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  189-95     Citation Subset:  AIM; IM    
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MeSH Terms
Age Factors
Aged, 80 and over
Boston / epidemiology
Cause of Death / trends*
Drug Overdose / mortality
Homeless Persons / statistics & numerical data*
Middle Aged
Mortality / ethnology
Retrospective Studies
Sex Factors
Young Adult
Grant Support
Comment In:
JAMA Intern Med. 2013 Jul 8;173(13):1265-6   [PMID:  23836272 ]
JAMA Intern Med. 2013 Jul 8;173(13):1264   [PMID:  23836270 ]
JAMA Intern Med. 2013 Jul 8;173(13):1264-5   [PMID:  23836271 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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