Cawley Caroline, Kanzaria Hemal K, Zevin Barry, Doran Kelly M, Kushel Margot, Raven Maria C
Department of Emergency Medicine, University of California, San Francisco.
Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco.
JAMA Netw Open. 2022 Mar 1;5(3):e221870. doi: 10.1001/jamanetworkopen.2022.1870.
There has been recent media attention on the risk of excess mortality among homeless individuals during the COVID-19 pandemic, yet data on these deaths are limited.
To quantify and describe deaths among people experiencing homelessness in San Francisco during the COVID-19 pandemic and to compare the characteristics of these deaths with those in prior years.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study tracking mortality among people experiencing homelessness from 2016 to 2021 in San Francisco, California. All deceased individuals who were homeless in San Francisco at the time of death and whose deaths were processed by the San Francisco Office of the Chief Medical Examiner were included. Data analysis was performed from August to October 2021.
Homelessness, based on homeless living status in an administrative database.
Descriptive statistics were used to understand annual trends in demographic characteristics, cause and manner of death (based on autopsy), substances present in toxicology reports, geographic distribution of deaths, and use of health and social services prior to death. Total estimated numbers of people experiencing homelessness in San Francisco were assessed through semiannual point-in-time counts. The 2021 point-in-time count was postponed owing to the COVID-19 pandemic.
In San Francisco, there were 331 deaths among people experiencing homelessness in the first year of the COVID-19 pandemic (from March 17, 2020, to March 16, 2021). This number was more than double any number in previous years (eg, 128 deaths in 2016, 128 deaths in 2017, 135 deaths in 2018, and 147 deaths in 2019). Most individuals who died were male (268 of 331 [81%]). Acute drug toxicity was the most common cause of death in each year, followed by traumatic injury. COVID-19 was not listed as the primary cause of any deaths. The proportion of deaths involving fentanyl increased each year (present in 52% of toxicology reports in 2019 and 68% during the pandemic). Fewer decedents had contacts with health services in the year prior to their death during the pandemic than in prior years (13% used substance use disorder services compared with 20% in 2019).
In this cross-sectional study, the number of deaths among people experiencing homelessness in San Francisco increased markedly during the first year of the COVID-19 pandemic. These findings may guide future interventions to reduce mortality among individuals experiencing homelessness.
近期媒体关注了新冠疫情期间无家可归者的超额死亡风险，但关于这些死亡的数据有限。
量化并描述新冠疫情期间旧金山无家可归者的死亡情况，并将这些死亡特征与前几年进行比较。
设计、背景和参与者：一项横断面研究，追踪2016年至2021年加利福尼亚州旧金山无家可归者的死亡率。纳入所有在死亡时居住在旧金山且死亡由旧金山首席法医办公室处理的无家可归者。数据分析于2021年8月至10月进行。
基于行政数据库中的无家可归居住状况。
使用描述性统计来了解人口统计学特征、死亡原因和方式（基于尸检）、毒理学报告中存在的物质、死亡的地理分布以及死亡前健康和社会服务使用情况的年度趋势。通过半年一次的即时点数评估旧金山无家可归者的估计总数。由于新冠疫情，2021年的即时点数推迟。
在旧金山，新冠疫情第一年（2020年3月17日至2021年3月16日）有331名无家可归者死亡。这一数字比前几年的任何数字都增加了一倍多（例如，2016年有128人死亡，2017年有128人死亡，2018年有135人死亡，2019年有147人死亡）。大多数死亡者为男性（331人中有268人[81%]）。急性药物中毒是每年最常见的死亡原因，其次是创伤性损伤。新冠病毒未被列为任何死亡的主要原因。涉及芬太尼的死亡比例逐年增加（2019年毒理学报告中有52%出现，疫情期间为68%）。与前几年相比在疫情期间死亡前一年与卫生服务机构接触的死者较少（13%使用物质使用障碍服务，而2019年为20%）。
在这项横断面研究中，旧金山无家可归者的死亡人数在新冠疫情第一年显著增加。这些发现可能为未来降低无家可归者死亡率的干预措施提供指导。
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