Abstract
Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004.Methods. Using data collected from a longitudinal, venue-based sample of street youth 15–24 years of age, we calculated age, race, and gender-adjusted mortality rates.Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3–18.9]). Gender specific SMRs were 16.1 (95% CI [3.3–47.1]) for females and 9.4 (95% CI [4.0–18.4]) for males.Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the state’s general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population.
Highlights
Homeless youth experience a disproportionate risk for morbidity, including, but not limited to, HIV and other sexually transmitted infections, Hepatitis B and C, and psychiatric disorders (DeMatteo et al, 1999; Ensign & Gittelsohn, 1998; Hahn et al, 2001; Kennedy, 1991; Larkin Steet Youth Services, 2014; Noell et al, 2001; Roy et al, 1999)
Homeless adults have been shown to experience increased mortality (Hwang, 2000; Nordentoft & WandallHolm, 2003; Alstrom, Lindelius & Salum, 1975; Babidge, Buhrich & Butler, 2001; Barrow et al, 1999; Beijer et al, 2011; Cheung & Hwang, 2004; Hibbs et al, 1994; Hwang et al, 1997; Metraux et al, 2011; Nielsen et al, 2011; Shaw & Dorling, 1998; Baggett et al, 2013; Nusselder et al, 2013). This elevated risk of mortality may be especially high amongst homeless youth
Of those reporting age- and gender-specific standardized mortality ratios (SMR), youth SMRs ranged from 2.1 to 37.32, generally higher than the SMRs found amongst older participants in the same studies (Hwang, 2000; Nordentoft & Wandall-Holm, 2003; Alstrom, Lindelius & Salum, 1975; Babidge, Buhrich & Butler, 2001; Barrow et al, 1999; Hibbs et al, 1994; Hwang et al, 1997; Roy et al, 2010; Roy et al, 2004)
Summary
Homeless youth experience a disproportionate risk for morbidity, including, but not limited to, HIV and other sexually transmitted infections, Hepatitis B and C, and psychiatric disorders (DeMatteo et al, 1999; Ensign & Gittelsohn, 1998; Hahn et al, 2001; Kennedy, 1991; Larkin Steet Youth Services, 2014; Noell et al, 2001; Roy et al, 1999). Homeless adults have been shown to experience increased mortality (Hwang, 2000; Nordentoft & WandallHolm, 2003; Alstrom, Lindelius & Salum, 1975; Babidge, Buhrich & Butler, 2001; Barrow et al, 1999; Beijer et al, 2011; Cheung & Hwang, 2004; Hibbs et al, 1994; Hwang et al, 1997; Metraux et al, 2011; Nielsen et al, 2011; Shaw & Dorling, 1998; Baggett et al, 2013; Nusselder et al, 2013) This elevated risk of mortality may be especially high amongst homeless youth. Of those reporting age- and gender-specific standardized mortality ratios (SMR), youth SMRs ranged from 2.1 to 37.32, generally higher than the SMRs found amongst older participants in the same studies (Hwang, 2000; Nordentoft & Wandall-Holm, 2003; Alstrom, Lindelius & Salum, 1975; Babidge, Buhrich & Butler, 2001; Barrow et al, 1999; Hibbs et al, 1994; Hwang et al, 1997; Roy et al, 2010; Roy et al, 2004)
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