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Cited by 567Homelessness and Social IssuesHIV, Drug Use, Sexual RiskOpioid Use Disorder Treatment

The DOI matches its Crossref record, with a small difference in title or year; 37 of the 38 references it cites were found in a registry or an index.

Mortality Among Homeless Adults in Boston: Shifts in Causes of Death Over a 15-Year Period

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Baggett, Travis P., Hwang, Stephen W., O’Connell, James J., Porneala, Bianca C., Stringfellow, Erin J., Orav, E. John, Singer, Daniel E., Rigotti, Nancy A.·2013·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2013.1604PMC PMC3713619
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Abstract

BACKGROUND: Homeless persons experience excess mortality, but US-based studies on this topic are outdated or lack information about causes of death.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.

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  1. [28]Rothman KJ Greenland S Modern Epidemiology 1998 Lippincott Philadelphia 2nd ed
  2. [36]Rosenheck R Bassuk EL Salomon A Special Populations of Homeless Americans 1998 Paper presented at: National Symposium on Homelessness Research: What Works? Arlington, VA

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Authors
Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., Singer, D. E., & Rigotti, N. A.
Affiliations
  • Massachusetts General Hospital (US)
  • St. Michael's Hospital (CA)
  • Washington University in St. Louis (US)
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2013-02-11
Volume
173
Issue
3
Pages
189
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2013.1604
PMC
PMC3713619
OpenAlex
W2133962053
Cited by
566
References
38
Citations by year
2026: 24 · 2025: 45 · 2024: 52 · 2023: 49 · 2022: 60 · 2021: 64 · 2020: 57 · 2019: 46 · 2018: 37 · 2017: 28 · 2016: 36 · 2015: 31 · 2014: 22 · 2013: 13
FWCI
61.26
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (T32MH019960)
  • National Institute on Drug Abuse (K23DA034008)
Topics
  • Social Sciences › Sociology and Political Science › Homelessness and Social Issues
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
homelessness, mortality, causes of death, drug overdose, opioid overdose, HIV, cancer, heart disease, substance use disorders, racial disparities, temporal trends, behavioral health integration
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Boston, Cause of Death, Female, Ill-Housed Persons, Humans, Male, Middle Aged, Mortality, Retrospective Studies, Sex Factors, Young Adult, Drug Overdose

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