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
Open accessAbstract
BACKGROUND: Homeless persons experience excess mortality, but US-based studies on this topic are outdated or lack information about causes of death.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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“Findings from several studies have shown that mortality is substantially increased in homeless people,35-45 with the excess risk most evident in younger people39,46 and, in some studies, women.”
From The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations (2014) · cites this paper as [43]
In the citing paper
“The high excess mortality in the current century is in line with a recent study reporting that in 2003–2008 the mortality rate of 18–64 year-old homeless in Boston has not changed as compared to 1988–1993 [15].”
From Mortality and life expectancy in homeless men and women in Rotterdam: 2001-2010 (2013) · cites this paper as [15]
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Citations
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Self-citationMortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study
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Self-citationPrescription Drug Monitoring Programs and Death Rates from Drug Overdose
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Homelessness as an independent risk factor for mortality: results from a retrospective cohort study
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Mortality in a Cohort of Homeless Adults in Philadelphia
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Fazel, S., Geddes, J. R., & Kushel, M. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61132-6 · Cited by 1,568
COVID-19: a potential public health problem for homeless populations
Tsai, J., & Wilson, M. (2020) · The Lancet Public Health · doi:10.1016/s2468-2667(20)30053-0 · Cited by 695
Humphreys, K. N., Shover, C. L., Andrews, C. M., Bohnert, A. S. B., Brandeau, M. L., Caulkins, J. P., Chen, J. H., Cuéllar, M.-F., Hurd, Y. L., Juurlink, D. N., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02252-2 · Cited by 489
Community Interventions to Promote Mental Health and Social Equity
Castillo, E. G., Ijadi-Maghsoodi, R., Shadravan, S., Moore, E., Mensah, M. O., Docherty, M., Aguilera Nunez, M. G., Barcelo, N., Goodsmith, N., Halpin, L. E., et al. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1017-0 · Cited by 387
Gutwinski, S., Schreiter, S., Deutscher, K., & Fazel, S. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003750 · Cited by 347
Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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