Mortality by Age, Gender, and Race and Ethnicity in People Experiencing Homelessness in Boston, Massachusetts

Abstract

ImportancePeople experiencing homelessness (PEH) face disproportionately high mortality rates compared with the general population, but few studies have examined mortality in this population by age, gender, and race and ethnicity.ObjectiveTo evaluate all-cause and cause-specific mortality in a large cohort of PEH by age, gender, and race and ethnicity.Design, Setting, and ParticipantsAn observational cohort study was conducted from January 1, 2003, to December 31, 2018. All analyses were performed between March 16, 2021, and May 12, 2022. A cohort of adults (age ≥18 years) seen at the Boston Health Care for the Homeless Program (BHCHP), a large federally funded Health Care for the Homeless organization in Boston, Massachusetts, from January 1, 2003, to December 31, 2017, was linked to Massachusetts death occurrence files spanning January 1, 2003, to December 31, 2018.Main Outcomes and MeasuresAge-, gender-, and race and ethnicity–stratified all-cause and cause-specific mortality rates were examined and compared with rates in the urban Northeast US population using mortality rate ratios (RRs).ResultsAmong the 60 092 adults included in the cohort with a median follow-up of 8.6 (IQR, 5.1-12.5) years, 7130 deaths occurred. The mean (SD) age at death was 53.7 (13.1) years; 77.5% of decedents were men, 21.0% Black, 10.0% Hispanic/Latinx, and 61.5% White. The all-cause mortality rate was 1639.7 deaths per 100 000 person-years among men and 830 deaths per 100 000 person-years among women. The all-cause mortality rate was highest among White men aged 65 to 79 years (4245.4 deaths per 100 000 person-years). Drug overdose was a leading cause of death across age, gender, and race and ethnicity groups, while suicide uniquely affected young PEH and HIV infection and homicide uniquely affected Black and Hispanic/Latinx PEH.Conclusions and RelevanceIn this large cohort study of PEH, all-cause and cause-specific mortality varied by age, gender, and race and ethnicity. Tailored interventions focusing on those at elevated risk for certain causes of death are essential for reducing mortality disparities across homeless-experienced groups.

Health Care for People Experiencing Homelessness

“…Compared with the general population (and adjusted for race), men and women experiencing homelessness aged 25 to 44 years were, respectively, 8.6 (95% CI, 7.4-9.9) and 9.6 (7.4-12.4) times more likely to die and those aged 45 to 64 years were 4.5 times more likely to die (95% CI, 4.1-4.9 for men and 3.6-5.6 for women) . Causes of death vary by age; in a cohort study of 60 092 people experiencing homelessness in Boston, drug overdose was the leading cause of death overall, although cardiovascular disease and cancer were the leading causes of death among those aged 50 years and older …”

“…5 Causes of death vary by age; in a cohort study of 60 092 people experiencing homelessness in Boston, drug overdose was the leading causeofdeathoverall,althoughcardiovasculardiseaseandcancerwere the leading causes of death among those aged 50 years and older. 6 Homelessness and Health Care Use People experiencing homelessness have limited access to primary care for reasons including absence of health insurance, lack of money for co-payments or transportation, and communication barriers. With poor health and high rates of injuries, people experiencing homelessness have high rates of emergency department (ED) use and hospitalization.…”

Associations among Drug Acquisition and Use Behaviors, Psychosocial Attributes, and Opioid-Involved Overdoses: A SEM Analysis

“…Additional studies and systematic reviews have identified factors other than gender and drug use behaviors that are associated with increased opioid-involved overdose and fatality risk. Some of the identified categorical risk factors include: systemic (e.g., stigma); psychosocial (e.g., unstably housed or homeless, serious mental illness, trauma exposure); demographics (e.g., age, racial/ethnic minority, low socioeconomic status), and circumstantial (e.g., a particular dealer supplying a “hot dose”, recent release from jail or prison affecting physical tolerance, fluctuations in potency in the local illegal opioid supply) ( 15 – 28 ).…”

Error in Figure 2

“…In the Original Investigation titled “Mortality by Age, Gender, and Race and Ethnicity in People Experiencing Homelessness in Boston, Massachusetts,” published August 31, 2023, there was an error in the x-axis of Figure 2. The first grouping of data given as “All men” should have been “All women.” This article has been corrected …”

“…The first grouping of data given as “All men” should have been “All women.” This article has been corrected. 1 …”