{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:35:56Z","timestamp":1791272156586,"version":"4.1.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>People experiencing homelessness (PEH) face disproportionately high mortality rates compared with the general population, but few studies have examined mortality in this population by age, gender, and race and ethnicity.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate all-cause and cause-specific mortality in a large cohort of PEH by age, gender, and race and ethnicity.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>An observational cohort study was conducted from January 1, 2003, to December 31, 2018. All analyses were performed between March 16, 2021, and May 12, 2022. A cohort of adults (age \u226518 years) seen at the Boston Health Care for the Homeless Program (BHCHP), a large federally funded Health Care for the Homeless organization in Boston, Massachusetts, from January 1, 2003, to December 31, 2017, was linked to Massachusetts death occurrence files spanning January 1, 2003, to December 31, 2018.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Age-, gender-, and race and ethnicity\u2013stratified all-cause and cause-specific mortality rates were examined and compared with rates in the urban Northeast US population using mortality rate ratios (RRs).<\/jats:p><\/jats:sec>Results<\/jats:title>Among the 60\u202f092 adults included in the cohort with a median follow-up of 8.6 (IQR, 5.1-12.5) years, 7130 deaths occurred. The mean (SD) age at death was 53.7 (13.1) years; 77.5% of decedents were men, 21.0% Black, 10.0% Hispanic\/Latinx, and 61.5% White. The all-cause mortality rate was 1639.7 deaths per 100\u202f000 person-years among men and 830 deaths per 100\u202f000 person-years among women. The all-cause mortality rate was highest among White men aged 65 to 79 years (4245.4 deaths per 100\u202f000 person-years). Drug overdose was a leading cause of death across age, gender, and race and ethnicity groups, while suicide uniquely affected young PEH and HIV infection and homicide uniquely affected Black and Hispanic\/Latinx PEH.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this large cohort study of PEH, all-cause and cause-specific mortality varied by age, gender, and race and ethnicity. Tailored interventions focusing on those at elevated risk for certain causes of death are essential for reducing mortality disparities across homeless-experienced groups.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.31004","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T15:58:44Z","timestamp":1693497524000},"page":"e2331004","source":"Crossref","is-referenced-by-count":19,"title":["Mortality by Age, Gender, and Race and Ethnicity in People Experiencing Homelessness in Boston, Massachusetts"],"prefix":"10.1001","volume":"6","author":[{"given":"Danielle R.","family":"Fine","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten A.","family":"Dickins","sequence":"additional","affiliation":[{"name":"Community, Systems and Mental Health Nursing Department, Rush University Medical Center, Chicago, Illinois"},{"name":"Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Logan D.","family":"Adams","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora K.","family":"Horick","sequence":"additional","affiliation":[{"name":"Biostatistics Center, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Critchley","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Hart","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie M.","family":"Gaeta","sequence":"additional","affiliation":[{"name":"The Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts"},{"name":"Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Lewis","sequence":"additional","affiliation":[{"name":"The Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts"},{"name":"Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E.","family":"Looby","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston"},{"name":"Metabolism Unit, Endocrinology Division, Department of Medicine, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis P.","family":"Baggett","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"The Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"issue":"3","key":"zoi230894r4","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1111\/hesr.2013.48.issue-3","article-title":"Health status and health care experiences among homeless patients in federally supported health centers: findings from the 2009 patient survey.","volume":"48","author":"Lebrun-Harris","year":"2013","journal-title":"Health Serv Res"},{"issue":"9953","key":"zoi230894r5","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations.","volume":"384","author":"Fazel","year":"2014","journal-title":"Lancet"},{"issue":"3","key":"zoi230894r6","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1001\/jamainternmed.2013.1604","article-title":"Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period.","volume":"173","author":"Baggett","year":"2013","journal-title":"JAMA Intern Med"},{"issue":"5","key":"zoi230894r7","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1056\/NEJM199408043310506","article-title":"Mortality in a cohort of homeless adults in Philadelphia.","volume":"331","author":"Hibbs","year":"1994","journal-title":"N Engl J Med"},{"issue":"8","key":"zoi230894r8","doi-asserted-by":"publisher","first-page":"625","DOI":"10.7326\/0003-4819-126-8-199704150-00007","article-title":"Causes of death in homeless adults in Boston.","volume":"126","author":"Hwang","year":"1997","journal-title":"Ann Intern Med"},{"issue":"4","key":"zoi230894r9","doi-asserted-by":"publisher","first-page":"529","DOI":"10.2105\/AJPH.89.4.529","article-title":"Mortality among homeless shelter residents in New York City.","volume":"89","author":"Barrow","year":"1999","journal-title":"Am J Public Health"},{"issue":"3","key":"zoi230894r10","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/00005053-200003000-00003","article-title":"Mortality among homeless and nonhomeless mentally ill veterans.","volume":"188","author":"Kasprow","year":"2000","journal-title":"J Nerv Ment Dis"},{"issue":"2","key":"zoi230894r11","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1177\/0033354918755709","article-title":"Mortality and cause of death in younger homeless veterans.","volume":"133","author":"Schinka","year":"2018","journal-title":"Public Health Rep"},{"issue":"5","key":"zoi230894r13","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1001\/jamainternmed.2022.7011","article-title":"Mortality trends among adults experiencing homelessness in Boston, Massachusetts From 2003 to 2018.","volume":"183","author":"Dickins","year":"2023","journal-title":"JAMA Intern Med"},{"issue":"1","key":"zoi230894r14","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.42676","article-title":"Drug overdose mortality among people experiencing homelessness, 2003 to 2018.","volume":"5","author":"Fine","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi230894r15","doi-asserted-by":"publisher","first-page":"b4036","DOI":"10.1136\/bmj.b4036","article-title":"Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study.","volume":"339","author":"Hwang","year":"2009","journal-title":"BMJ"},{"issue":"9","key":"zoi230894r16","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1001\/jamainternmed.2018.2924","article-title":"Mortality among unsheltered homeless adults in Boston, Massachusetts, 2000-2009.","volume":"178","author":"Roncarati","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"8","key":"zoi230894r17","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.2105\/AJPH.2009.173609","article-title":"The Boston Health Care for the Homeless Program: a public health framework.","volume":"100","author":"O\u2019Connell","year":"2010","journal-title":"Am J Public Health"},{"issue":"3","key":"zoi230894r21","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0477","article-title":"Office-based addiction treatment retention and mortality among people experiencing homelessness.","volume":"4","author":"Fine","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi230894r22","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.2105\/AJPH.2014.302248","article-title":"Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston.","volume":"105","author":"Baggett","year":"2015","journal-title":"Am J Public Health"},{"issue":"6","key":"zoi230894r24","first-page":"1","article-title":"Deaths: leading causes for 2017.","volume":"68","author":"Heron","year":"2019","journal-title":"Natl Vital Stat Rep"},{"issue":"1","key":"zoi230894r27","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1080\/08897077.2016.1264534","article-title":"Factors associated with substance use in older homeless adults: results from the HOPE HOME study.","volume":"38","author":"Spinelli","year":"2017","journal-title":"Subst Abus"},{"issue":"2","key":"zoi230894r28","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1080\/10530789.2017.1363505","article-title":"A qualitative analysis of suicide risk factors, preferred means, and means restriction feasibility within a homeless shelter environment.","volume":"26","author":"Poon","year":"2017","journal-title":"J Soc Distress Homeless"},{"issue":"1","key":"zoi230894r29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/sf\/soz127","article-title":"The enduring influence of cohort characteristics on race-specific homicide rates.","volume":"99","author":"Vogel","year":"2020","journal-title":"Soc Forces"},{"issue":"4","key":"zoi230894r30","first-page":"81","article-title":"Mortality among Blacks or African Americans with HIV infection\u2014United States, 2008-2012.","volume":"64","author":"Siddiqi","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"zoi230894r31","first-page":"8","article-title":"Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics.","volume":"1989","author":"Crenshaw","year":"1989","journal-title":"Univ Chic Leg Forum"},{"issue":"1","key":"zoi230894r32","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1177\/0002716221991040","article-title":"Racial inequity and homelessness: findings from the SPARC Study.","volume":"693","author":"Olivet","year":"2021","journal-title":"Annals Am Acad Pol"},{"issue":"6","key":"zoi230894r33","first-page":"639","article-title":"Comparison of White and non-White homeless men and women.","volume":"39","author":"North","year":"1994","journal-title":"Soc Work"},{"issue":"1","key":"zoi230894r34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.32086","article-title":"Comparison of all-cause mortality rates and inequities between Black and White populations across the 30 most populous US cities.","volume":"4","author":"Benjamins","year":"2021","journal-title":"JAMA Netw Open"},{"key":"zoi230894r20","volume-title":"National Death Index User\u2019s Guide","author":"National Center for Health Statistics","year":"2013"},{"key":"zoi230894r26","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511814365","volume-title":"Regression Analysis of Count Data","author":"Cameron","year":"1998"},{"key":"zoi230894r1","unstructured":"Henry? M, De Sousa? T, Roddey? C, . The 2020 Annual Homeless Assessment Report (AHAR) to Congress. January 2021. Accessed August 1, 2023. https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2020-AHAR-Part-1.pdf"},{"key":"zoi230894r2","unstructured":"National Alliance to End Homelessness. State of homelessness: 2021 edition. Accessed August 1, 2023. https:\/\/endhomelessness.org\/homelessness-in-america\/homelessness-statistics\/state-of-homelessness-2021\/"},{"key":"zoi230894r3","unstructured":"The Aspen Institute. The COVID-19 eviction crisis: an estimated 30-40 million people in America are at risk. August 7, 2020. Accessed August 1, 2023. https:\/\/www.aspeninstitute.org\/blog- posts\/the-covid-19-eviction-crisis-an-estimated-30-40-million-people-in-america-are-at-risk\/"},{"key":"zoi230894r12","unstructured":"Los Angeles County Department of Public Health, Center for Health Impact Evaluation, Recent Trends In Mortality Rates and Causes of Death Among People Experiencing Homelessness in Los Angeles County. January 2021. Accessed August 1, 2023. http:\/\/www.publichealth.lacounty.gov\/chie\/reports\/HomelessMortality2020_CHIEBrief_Final.pdf"},{"key":"zoi230894r18","unstructured":"Boston Health Care for the Homeless Program. About us. Accessed August 1, 2023. https:\/\/www.bhchp.org\/about-us"},{"key":"zoi230894r19","unstructured":"Dusetzina? SB, Tyree? S, Meyer? AM, Meyer? A, Green? L, Carpenter? WR. Linking data for health services research: a framework and instructional guide. Agency for Healthcare Research and Quality, report No. 14-EHC033-EF. September 2014. Accessed August 3, 2023. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK253313\/pdf\/Bookshelf_NBK253313.pdf"},{"key":"zoi230894r23","unstructured":"Centers for Disease Control and Prevention [CDC]. Underlying cause of death 1999-2019. Accessed August 1, 2023. https:\/\/wonder.cdc.gov\/wonder\/help\/ucd.html"},{"key":"zoi230894r25","unstructured":"US Department of Health and Human Services [HHS], Centers for Disease Control and Prevention [CDC]. CDC Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER). 2021. Accessed August 1, 2023. https:\/\/wonder.cdc.gov\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2808940\/fine_2023_oi_230894_1695410682.76776.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T15:12:41Z","timestamp":1696345961000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2808940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,31]]},"references-count":34,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.31004","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,31]]}}}