Lachaud James, Nisenbaum Rosane, Mejia-Lancheros Cilia, Latimer Eric, Aubry Tim, Woodhall-Melnik Julia, Distasio Jino, Hinds Aynslie, Dutton Daniel, Somers Julian, Moniruzzaman Akm, Stergiopoulos Vicky, O'Campo Patricia, Hwang Stephen W
MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
College of Social Work, The Ohio State University, Columbus.
JAMA Netw Open. 2025 Jul 1;8(7):e2524302. doi: 10.1001/jamanetworkopen.2025.24302.
Homelessness is an important risk factor for premature death, with individuals experiencing homelessness having substantially higher mortality rates than the general population.
To assess the association of housing and support interventions with mortality among individuals experiencing homelessness and mental illnesses.
DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of a randomized clinical trial included 2255 homeless adults with mental illnesses. The study was conducted in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, and Moncton). Recruitment took place from October 2009 to July 2011; mortality data were collected until March 30, 2019. Due to the complexity of accessing health administrative data, analyses were conducted and completed between February 2021 and December 2023.
Participants were randomized to receive either the Housing First (HF) intervention, which provided immediate permanent, scattered-site housing and support through intensive case management or assertive community treatment to chronically homeless individuals, or treatment as usual (TAU).
Mortality rate ratios were ascertained at each site using health administrative databases. Adjusted hazard ratios were computed using Cox proportional hazard survival models. Random-effects meta-analysis was used to calculate pooled effect sizes across sites.
Of the 2255 total participants, 2108 (93.5%) were successfully linked with health administrative data; among them, 1434 (68.0%) were male, with a mean (SD) age of 40.6 (11.5) years. Mortality rates were not different in the HF compared with TAU groups (pooled log mortality rate ratio, -0.07; 95% CI, -0.36 to 0.22). The pooled adjusted hazard ratio comparing mortality in the HF and TAU groups was 0.83 (95% CI, 0.43-1.22).
In this secondary analysis of a randomized clinical trial, the HF intervention was not directly associated with mortality risk. Research is needed to determine whether adjunctive interventions could reduce mortality among homeless individuals with mental illnesses.
isrctn.org Identifier: ISRCTN42520374.
无家可归是过早死亡的一个重要风险因素，无家可归者的死亡率远高于普通人群。
评估住房和支持干预措施与无家可归且患有精神疾病者死亡率之间的关联。
设计、地点和参与者：这项对一项随机临床试验的二次分析纳入了2255名患有精神疾病的无家可归成年人。研究在加拿大5个城市（温哥华、温尼伯、多伦多、蒙特利尔和蒙克顿）进行。招募时间为2009年10月至2011年7月；死亡率数据收集至2019年3月30日。由于获取卫生行政数据的复杂性，分析于2021年2月至2023年12月进行并完成。
参与者被随机分为接受“住房优先”（HF）干预组或常规治疗（TAU）组。“住房优先”干预为长期无家可归者提供即时的永久性分散式住房，并通过强化个案管理或积极社区治疗提供支持。
使用卫生行政数据库确定每个地点的死亡率比值。使用Cox比例风险生存模型计算调整后的风险比。采用随机效应荟萃分析计算各地点的合并效应量。
在2255名总参与者中，2108名（93.5%）成功与卫生行政数据建立关联；其中，1434名（68.0%）为男性，平均（标准差）年龄为40.6（11.5）岁。HF组与TAU组的死亡率无差异（合并对数死亡率比值为-0.07；95%置信区间为-0.36至0.22）。比较HF组和TAU组死亡率的合并调整后风险比为0.83（95%置信区间为0.43 - 1.22）。
在这项对随机临床试验的二次分析中，HF干预与死亡风险无直接关联。需要开展研究以确定辅助干预措施是否能降低患有精神疾病的无家可归者的死亡率。
isrctn.org标识符：ISRCTN42520374。
