Department of Public Health, Santa Clara University, Santa Clara, California, United States of America.
Office of the Medical Examiner-Coroner, County of Santa Clara, San Jose, California, United States of America.
PLoS One. 2023 Feb 16;18(2):e0281912. doi: 10.1371/journal.pone.0281912. eCollection 2023.
The number of people dying while unhoused is increasing nationally. In Santa Clara County (SCC), deaths of unhoused people have almost tripled in 9 years. This is a retrospective cohort study examining mortality trends among unhoused people in SCC. The objective of the study is to characterize mortality outcomes in the unhoused population, and compare these to the SCC general population.
We obtained data from the SCC Medical Examiner-Coroner's Office on unhoused people's deaths that occurred between 2011-2019. We analyzed demographic trends and cause of death, compared to mortality data on the SCC general population obtained from CDC databases. We also compared rates of deaths of despair.
There were a total of 974 unhoused deaths in the SCC cohort. The unadjusted mortality rate among unhoused people is higher than the general population, and unhoused mortality has increased over time. The standardized mortality ratio for unhoused people is 3.8, compared to the general population in SCC. The most frequent age of death among unhoused people was between 55-64 years old (31.3%), followed by 45-54 (27.5%), compared to 85+ in the general population (38.3%). Over ninety percent of deaths in the general population were due to illness. In contrast, 38.2% of unhoused deaths were due to substance use, 32.0% illness, 19.0% injury, 4.2% homicide, and 4.1% suicide. The proportion of deaths of despair was 9-fold higher in the unhoused cohort compared to the housed cohort.
Homelessness has profound impacts on health, as people who are unhoused are dying 20 years younger, with higher rates of injurious, treatable, and preventable causes, than people in the general population. System-level, inter-agency interventions are needed. Local governments need to systematically collect housing status at death to monitor mortality patterns among unhoused people, and adapt public health systems to prevent rising unhoused deaths.
全国范围内无家可归者死亡人数不断增加。在圣克拉拉县（SCC），无家可归者的死亡人数在 9 年内几乎增加了两倍。这是一项回顾性队列研究，旨在研究 SCC 中无家可归者的死亡趋势。本研究的目的是描述无家可归人群的死亡结局，并将其与 SCC 普通人群进行比较。
我们从 SCC 法医办公室获得了 2011 年至 2019 年期间无家可归者死亡的数据。我们分析了人口趋势和死因，并与从疾病控制与预防中心数据库获得的 SCC 普通人群的死亡数据进行了比较。我们还比较了绝望导致的死亡率。
SCC 队列中有 974 名无家可归者死亡。无家可归者的未调整死亡率高于普通人群，且随着时间的推移无家可归者的死亡率有所增加。无家可归者的标准化死亡率比 SCC 普通人群高 3.8 倍。无家可归者死亡的最常见年龄在 55-64 岁之间（31.3%），其次是 45-54 岁（27.5%），而普通人群中 85 岁以上的人占 38.3%。普通人群中超过 90%的死亡是由疾病引起的。相比之下，38.2%的无家可归者死亡是由于药物使用、32.0%的疾病、19.0%的损伤、4.2%的他杀和 4.1%的自杀。与有住房的人群相比，无家可归者人群中绝望导致的死亡率高 9 倍。
无家可归对健康有深远的影响，因为无家可归者的死亡年龄要早 20 岁，且因伤害、可治疗和可预防的原因而死亡的比例高于普通人群。需要系统层面的机构间干预。地方政府需要系统地收集死亡时的住房状况，以监测无家可归者的死亡模式，并调整公共卫生系统以防止无家可归者死亡人数的上升。
