Causes of death in homeless adults in Boston.

BACKGROUND

Homeless persons have high mortality rates.

OBJECTIVE

To ascertain causes of death in a group of homeless persons.

DESIGN

Cohort study.

PATIENTS

17,292 adults seen by the Boston Health Care for the Homeless Program from 1988 to 1993.

MEASUREMENTS

Cause-specific mortality rates adjusted for race and rate ratios that compare mortality rates in homeless persons with those in the general population of Boston.

RESULTS

Homicide was the leading cause of death among men who were 18 to 24 years of age (mortality rate, 242.7 per 100000 person-years; rate ratio, 4.1). The acquired immunodeficiency syndrome was the major cause of death in men (mortality rate, 336.5 per 100000 person-years; rate ratio, 2.0) and women (mortality rate, 116.0 per 100000 person-years; rate ratio, 5.0) who were 25 to 44 years of age. Heart disease and cancer were the leading causes of death in persons who were 45 to 64 years of age.

CONCLUSIONS

The most common causes of death among homeless adults who have contact with clinicians vary by age group. Efforts to reduce the rate of death among homeless persons should focus on these causes.