Difference in Survival between Housed and Homeless individuals with HIV, San Francisco, 2002–2011

Khanijow, Keshav; Hirozawa, Anne M.; Ancock, Benedict; Hsu, Ling; Bamberger, Joshua D.; Schwarcz, Sandra

doi:10.1353/hpu.2015.0071

“…Among all PLWH in San Francisco diagnosed with HIV from 2002 to 2006, the five-year survival rate for homeless individuals was 79% compared to 92% among housed individuals (p<0.001) 6 . However, among persons diagnosed with HIV more recently from 2007 to 2011 there was no difference in the five-year survival rate between homeless and housed people (p=0.40) 6 . A study analyzing a permanent supportive housing program in San Francisco found that among 6,558 AIDS cases diagnosed from 1996-2006 in San Francisco, the fiveyear survival rate for persons who were homeless was 67% compared to 81% among those who were housed under permanent supportive housing (p<0.0001) 7 .…”

Section: Introductionmentioning

confidence: 94%

A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco

Hessol

¹

,

Eng

²

,

Vu

³

et al. 2019

Preprint

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Background: San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. Methods: Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. Results: A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p<0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p<0.05). After adjustment, deaths due to mental disorders (aPR=1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR=0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. Conclusions: Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.

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“…Among all PLWH in San Francisco diagnosed with HIV from 2002 to 2006, the five-year survival rate for homeless individuals was 79% compared to 92% among housed individuals (p < 0.001) 6 . However, among persons diagnosed with HIV more recently from 2007 to 2011 there was no difference in the five-year survival rate between homeless and housed people (p = 0.40) 6 . In contrast to the improvement in mortality data, a 2017 study in San odds for achieving viral suppression with individuals living in shelters (adjusted odds ratio [OR] = 0.26, 95% CI 0.12, 0.59) and those living outdoors (adjusted OR = 0.15, 95% CI 0.08, 0.29) 7 .…”

Section: Introductionmentioning

confidence: 94%

A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco

Hessol

¹

,

Eng

²

,

Vu

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background San Francisco (SF) has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. Methods Individuals diagnosed with HIV/AIDS and reported to the SF Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in SF at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. Results A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p < 0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p < 0.05). After adjustment, deaths due to mental disorders (PR=1.61, 95% CI 1.23, 2.12) were more likely and deaths due to non-AIDS cancers (PR=0.63, 95% CI 0.44, 0.88) were less likely among those experiencing homelessness. Conclusions Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.

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“…Among all PLWH in San Francisco diagnosed with HIV from 2002 to 2006, the five-year survival rate for homeless individuals was 79% compared to 92% among housed individuals (p<0.001) 6 . However, among persons diagnosed with HIV more recently from 2007 to 2011 there was no difference in the five-year survival rate between homeless and housed people (p=0.40) 6 . In contrast to the improvement in mortality data, a 2017 study in San Francisco reported poorer HIV viral suppression among homeless PLWH.…”

mentioning

confidence: 94%

A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco

Hessol

¹

,

Eng

²

,

Vu

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. Methods: Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. Results: A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p<0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p<0.05). After adjustment, deaths due to mental disorders (aPR=1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR=0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. Conclusions: Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.

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Difference in Survival between Housed and Homeless individuals with HIV, San Francisco, 2002–2011

Cited by 10 publications

References 19 publications

A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco

A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco

A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco

A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco

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