Henwood Benjamin F, Byrne Thomas, Scriber Brynn
School of Social Work, University of Southern California, 1150 S. Olive Street, 14th Floor, Los Angeles, CA, 90015-2211, USA.
School of Social Work, Boston University, 264 Bay State Rd., Boston, MA, 02215, USA.
BMC Public Health. 2015 Dec 4;15:1209. doi: 10.1186/s12889-015-2552-1.
Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older.
This observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process.
The majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72% died from natural causes, compared to 49% from the homeless group. This included 21% of HF participants and 7% from the homeless group who died from cancer. Among homeless adults, 40% died from an accident, which was significantly more than the 14% of HF participants who died from an accident. HIV or other infectious diseases contributed to 13% of homeless deaths compared to only 2% of HF participants. Hypothermia contributed to 6% of homeless deaths, which was not a cause of death for HF participants.
Results suggest HF participants face excess mortality in comparison to members of the general population and that mortality rates among HF participants are higher than among those reported among members of the general homeless population in prior studies. However, findings also suggest that causes of death may differ between HF participants and their homeless counterparts. Specifically, chronic diseases appear to be more prominent causes of death among HF participants, indicating the potential need for integrating medical support and end-of-life care in HF.
经历长期无家可归的成年人死亡率是普通人群的3至4倍。“住房优先”（HF）是一种基于证据的做法，能有效终结长期无家可归的状况，但几乎没有关于HF项目参与者过早死亡的研究。在美国，尽管有研究表明长期无家可归的成年人构成了一个老龄化群体，近一半年龄在50岁及以上，但文献中仍存在这一空白。
这项观察性研究考察了一个HF项目中曾经无家可归的成年人的死亡率。我们研究了HF参与者的死亡率和死亡原因，并评估了HF参与者入住住房后的死亡时间和死亡预测因素。我们还比较了HF参与者与（a）普通人群成员和（b）无家可归者的死亡率。我们通过正式审查程序，将HF项目中死者的死亡原因和特征与同一城市中在死亡时被认定为无家可归的成年人样本进行比较，对这些分析进行了补充。
两组中的大多数死者死亡时年龄在45至64岁之间；HF参与者的平均死亡年龄为57岁，而无家可归样本中的个体为53岁。在HF组中，72%死于自然原因，而无家可归组为49%。这包括21%的HF参与者和7%的无家可归者死于癌症。在无家可归的成年人中，40%死于意外事故，这显著高于14%死于意外事故的HF参与者。艾滋病毒或其他传染病导致了13%的无家可归者死亡，而HF参与者中这一比例仅为2%。体温过低导致了6%的无家可归者死亡，这不是HF参与者的死亡原因。
结果表明，与普通人群成员相比，HF参与者面临更高的死亡率，且HF参与者的死亡率高于先前研究中报道的普通无家可归人群的死亡率。然而，研究结果还表明，HF参与者与其无家可归的同行之间的死亡原因可能不同。具体而言，慢性病似乎是HF参与者中更突出的死亡原因，这表明在HF项目中可能需要整合医疗支持和临终关怀。
