Fowle Matthew, Chang Jamie, Saxton Katherine
Weitzman School of Design, University of Pennsylvania, United States.
School of Social Welfare, University of California Berkeley, United States.
SSM Popul Health. 2024 Jun 20;27:101688. doi: 10.1016/j.ssmph.2024.101688. eCollection 2024 Sep.
Disparities in mortality between Black and White people have long been observed. These disparities persist at all income levels. However, similar patterns in racial mortality disparities are not observed among people experiencing homelessness. Instead, studies in a handful of cities show a reversal in the Black-White mortality disparity in the United States: Black people experiencing homelessness are less likely to die compared to White people experiencing homelessness. We propose a theory of "racial mortality inversion" and test whether inverted Black-White mortality patterns are observable in homeless populations throughout the United States. Using a novel dataset of 18,618 homeless decedents in 20 localities across 10 states and the District of Columbia, we find consistent evidence for "racial mortality inversion" across time and place. Between 2015 and 2020, the aggregate White homeless mortality rate was 67.8%-138.4% higher than the rate for the Black homeless population. Inverted racial mortality rates were observed in all 20 localities and in nearly every year. Across the entire sample, higher average ages of death were also observed for Black people compared to White people experiencing homelessness in 5 of 6 years, though racial inversion in age was not consistent across localities. These findings offer novel insight into racial health disparities among people experiencing homelessness and may inform policies and programs that seek to prevent homelessness and homeless mortality across racial groups.
长期以来，人们一直观察到黑人和白人在死亡率上存在差异。这些差异在所有收入水平上都持续存在。然而，在无家可归者中并未观察到类似的种族死亡率差异模式。相反，少数城市的研究表明，美国黑人和白人的死亡率差异出现了逆转：与无家可归的白人相比，无家可归的黑人死亡可能性更低。我们提出了一种“种族死亡率倒置”理论，并检验在美国各地的无家可归人群中是否能观察到黑白死亡率倒置模式。利用一个涵盖10个州和哥伦比亚特区20个地方的18618名无家可归死亡者的新数据集，我们发现了跨时间和地点的“种族死亡率倒置”的一致证据。在2015年至2020年期间，无家可归白人的总体死亡率比无家可归黑人的死亡率高67.8%-138.4%。在所有20个地方以及几乎每年都观察到了倒置的种族死亡率。在整个样本中，在6年中的5年里，与无家可归的白人相比，无家可归的黑人的平均死亡年龄也更高，不过年龄方面的种族倒置在不同地方并不一致。这些发现为无家可归者中的种族健康差异提供了新的见解，并可能为旨在预防各种族群体无家可归和无家可归者死亡的政策和项目提供参考。
