Abstract
BackgroundAdults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older.MethodsThis observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process.ResultsThe majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72 % died from natural causes, compared to 49 % from the homeless group. This included 21 % of HF participants and 7 % from the homeless group who died from cancer. Among homeless adults, 40 % died from an accident, which was significantly more than the 14 % of HF participants who died from an accident. HIV or other infectious diseases contributed to 13 % of homeless deaths compared to only 2 % of HF participants. Hypothermia contributed to 6 % of homeless deaths, which was not a cause of death for HF participants.ConclusionsResults suggest HF participants face excess mortality in comparison to members of the general population and that mortality rates among HF participants are higher than among those reported among members of the general homeless population in prior studies. However, findings also suggest that causes of death may differ between HF participants and their homeless counterparts. Specifically, chronic diseases appear to be more prominent causes of death among HF participants, indicating the potential need for integrating medical support and end-of-life care in HF.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2552-1) contains supplementary material, which is available to authorized users.
Highlights
Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population
Housing First (HF) has been adopted in multiple countries including the United States [9], Canada [10], Europe [11], and Australia [12], and effectively ends homelessness for people who have experienced a lifetime of cumulative adversity [13] and carry a significant disease burden based on multiple risk categories [14]
40 % died from an accident, which was significantly more than the 12 % of HF participants who died from an accident
Summary
Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population [1,2,3], and communities including New York City [4] and Philadelphia [5] have enacted surveillance systems to monitor and address mortality in this population. HF has been adopted in multiple countries including the United States [9], Canada [10], Europe [11], and Australia [12], and effectively ends homelessness for people who have experienced a lifetime of cumulative adversity [13] and carry a significant disease burden based on multiple risk categories [14]. In the United States, this gap in the literature exists despite research that suggests chronically homeless adults constitute an aging cohort; nearly half are aged 50 years old or older [15]
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