{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:42:43Z","timestamp":1793508163953,"version":"4.5.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Homelessness is an important risk factor for premature death, with individuals experiencing homelessness having substantially higher mortality rates than the general population.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the association of housing and support interventions with mortality among individuals experiencing homelessness and mental illnesses.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposure<\/jats:title>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).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>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, \u22120.07; 95% CI, \u22120.36 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).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>isrctn.org Identifier: ISRCTN42520374<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.24302","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T15:30:56Z","timestamp":1753975856000},"page":"e2524302","source":"Crossref","is-referenced-by-count":4,"title":["Housing and Support Intervention and Mortality Among Homeless Adults With Mental Illnesses"],"prefix":"10.1001","volume":"8","author":[{"given":"James","family":"Lachaud","sequence":"first","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"College of Social Work, The Ohio State University, 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