{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T21:32:17Z","timestamp":1767648737567,"version":"build-2065373602"},"reference-count":31,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/501100004810","name":"Samfundet Folkh\u00c3\u00a4lsan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004810","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010113","name":"Wilhelm och Else Stockmanns Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010113","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016238","name":"The Finnish Foundation for Alcohol Studies","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016238","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010135","name":"Finska L\u00c3\u00a4kares\u00c3\u00a4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010135","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2017,6,20]]},"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Homelessness is associated with increased mortality, and some predictors of mortality have been previously identified. We examined the overall and cause-specific mortality among homeless men in Helsinki and the associations of social background and health service use with mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>To assess cause-specific mortality in a competing risks framework, we performed a register-based, case\u2013control study of 617 homeless men and an age-matched control group of 1240 men from the general population that were followed for 10 years between 2004 and 2014. Cox proportional hazards model was used to calculate HR for death and a competing risks model to calculate sub-HRs (sHR) for cause-specific death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During the follow-up, 45.0% of the homeless died compared with 10.5% of controls (HR 5.38, 95% CI 4.39 to 6.59). The risk of death was particularly elevated for the homeless aged \u226450\u2009years (HR 10.3, 95%\u2009CI 7.0 to 15.2). External causes caused 34% of the deaths (sHR 11.2, 95%\u2009CI 6.8 to 18.2), but also deaths from medical causes were common (sHR 3.6, 95%\u2009CI 2.9 to 4.6). Age and somatic hospitalisation were significant predictors of death both among homeless and controls. Educational attainment, marital status, employment and psychiatric hospitalisation were significant predictors of mortality among the controls, but not among the homeless.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Homelessness is associated with a fivefold mortality compared with the controls, and especially homeless aged\u2009\u226450 years have an increased risk of death. Being homeless eliminates the protective effects of marriage, employment and education on mortality risk.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2017-209166","type":"journal-article","created":{"date-parts":[[2017,8,8]],"date-time":"2017-08-08T09:35:12Z","timestamp":1502184912000},"page":"841-848","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Mortality and causes of death among homeless in Finland: a 10-year follow-up study"],"prefix":"10.1136","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4070-5446","authenticated-orcid":false,"given":"Agnes","family":"Stenius-Ayoade","sequence":"first","affiliation":[{"name":"Folkh\u00e4lsan Research Center, Helsinki, Finland"},{"name":"Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland"},{"name":"Department of Social Services and Health Care, City of Helsinki, Helsinki, 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Dying without Dignity: Homeless Deaths in Los Angeles County: 2000 \u2013 2007; 2007."},{"key":"2025100310360044000_71.9.841.21","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-126-8-199704150-00007"},{"key":"2025100310360044000_71.9.841.22","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1001\/jamapsychiatry.2014.2502","article-title":"Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis","volume":"72","author":"Walker","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"2025100310360044000_71.9.841.23","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyr213"},{"key":"2025100310360044000_71.9.841.24","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017719"},{"key":"2025100310360044000_71.9.841.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0379-0738(00)00300-5"},{"key":"2025100310360044000_71.9.841.26","doi-asserted-by":"publisher","DOI":"10.2307\/2670170"},{"key":"2025100310360044000_71.9.841.27","unstructured":"Official Statistics of Finland (OSF). 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