{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:11:49Z","timestamp":1778771509184,"version":"3.51.4"},"reference-count":41,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T00:00:00Z","timestamp":1716249600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2019-01095"],"award-info":[{"award-number":["2019-01095"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det om H\u00e4lsa, Arbetsliv och V\u00e4lf\u00e4rd","doi-asserted-by":"publisher","award":["2020-00169"],"award-info":[{"award-number":["2020-00169"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2023,12,3]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>People in homelessness have an increased risk of substance use disorders (SUDs) and poor health outcomes. This cohort study aimed to investigate the association between homelessness and mortality in people with SUDs, adjusting for age, sex, narcotic use, intravenous drug use and inpatient care for SUDs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from the Swedish National Addiction Care Quality Register in the Stockholm region were used to analyse mortality risk in people with SUDs (n=8397), including 637 in homelessness, 1135 in precarious housing and 6625 in stable housing, at baseline. HRs and CIs were calculated using Cox regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mortality was increased for people in homelessness (HR 2.30; 95%\u2009CI 1.70 to 3.12) and precarious housing (HR 1.23; 95%\u2009CI 0.86 to 1.75) compared with those in stable housing. The association between homelessness and mortality decreased (HR 1.27; 95%\u2009CI 0.91 to 1.78) after adjusting for narcotic use (HR 1.28; 95%\u2009CI 1.00 to 1.63), intravenous drug use (HR 1.98; 95%\u2009CI 1.52 to 2.58) and inpatient care for SUDs (HR 1.96; 95%\u2009CI 1.57 to 2.45). Standardised mortality ratios (SMRs) showed that mortality among people in homelessness with SUDs was 13.6 times higher than the general population (SMR=13.6; 95%\u2009CI 10.2 to 17.9), and 3.7 times higher in people in stable housing with SUDs (SMR=3.7; 95%\u2009CI 3.2 to 4.1).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Homelessness increased mortality, but the risk decreased after adjusting for narcotic use, intravenous drug use and inpatient care for SUDs. Interventions are needed to reduce excess mortality among people in homelessness with SUDs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2023-220989","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T13:15:14Z","timestamp":1716297314000},"page":"473-478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Excess mortality among people in homelessness with substance use disorders: a Swedish cohort study"],"prefix":"10.1136","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-0433","authenticated-orcid":false,"given":"Sophie Nadia","family":"Gaber","sequence":"first","affiliation":[{"name":"Department of Healthcare Sciences, Marie Cederschi\u00f6ld h\u00f6gskola\u2014Campus Ersta, Stockholm, Sweden"},{"name":"Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden"},{"name":"Faculty of Brain Sciences, Division of Psychiatry, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4355-1967","authenticated-orcid":false,"given":"Johan","family":"Franck","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4209-5728","authenticated-orcid":false,"given":"H\u00e4rje","family":"Widing","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1658-9345","authenticated-orcid":false,"given":"Jonas","family":"H\u00e4llgren","sequence":"additional","affiliation":[{"name":"Academic Primary Care Center, Region Stockholm, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5104-1281","authenticated-orcid":false,"given":"Elisabet","family":"Mattsson","sequence":"additional","affiliation":[{"name":"Department of Healthcare Sciences, Marie Cederschi\u00f6ld h\u00f6gskola\u2014Campus Ersta, Stockholm, Sweden"},{"name":"Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8701-4226","authenticated-orcid":false,"given":"Jeanette","family":"Westman","sequence":"additional","affiliation":[{"name":"Department of Healthcare Sciences, Marie Cederschi\u00f6ld h\u00f6gskola\u2014Campus Ersta, Stockholm, Sweden"},{"name":"Academic Primary Care Center, Region Stockholm, Stockholm, Sweden"},{"name":"Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,5,21]]},"reference":[{"key":"2025100310302864000_78.8.473.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61132-6"},{"key":"2025100310302864000_78.8.473.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60747-2"},{"key":"2025100310302864000_78.8.473.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31869-X"},{"key":"2025100310302864000_78.8.473.4","unstructured":"Fondation Abb\u00e9 Pierre and FEANTSA . Seventh overview of housing exclusion in Europe. Brussels: FEANTSA, 2022."},{"key":"2025100310302864000_78.8.473.5","unstructured":"The Swedish National Board of Health and Welfare [Socialstyrelsen] . Homelessness 2017 \u2013 scope and characteristics [Heml\u00f6shet 2017 - Omfattning och Karakt\u00e4r]. 2017."},{"key":"2025100310302864000_78.8.473.6","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001435"},{"key":"2025100310302864000_78.8.473.7","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/1753-6405.13038","article-title":"Long-term effects of homelessness on mortality: a 15-year Australian cohort study","volume":"44","author":"Seastres","year":"2020","journal-title":"Aust N Z J Public Health"},{"key":"2025100310302864000_78.8.473.8","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s00127-017-1456-z","article-title":"Homelessness as a predictor of mortality: an 11-year register-based cohort study","volume":"53","author":"Feodor Nilsson","year":"2018","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"2025100310302864000_78.8.473.9","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2017-209166"},{"key":"2025100310302864000_78.8.473.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7406.81"},{"key":"2025100310302864000_78.8.473.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199408043310506"},{"key":"2025100310302864000_78.8.473.12","doi-asserted-by":"crossref","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"},{"key":"2025100310302864000_78.8.473.13","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.89.4.529"},{"key":"2025100310302864000_78.8.473.14","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyp160"},{"key":"2025100310302864000_78.8.473.15","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810393554"},{"key":"2025100310302864000_78.8.473.16","doi-asserted-by":"publisher","DOI":"10.1080\/08039480701644637"},{"key":"2025100310302864000_78.8.473.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0073979","article-title":"Mortality and life expectancy in homeless men and women in Rotterdam: 2001-2010","volume":"8","author":"Nusselder","year":"2013","journal-title":"PLoS One"},{"key":"2025100310302864000_78.8.473.18","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.302248"},{"key":"2025100310302864000_78.8.473.19","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckq033"},{"key":"2025100310302864000_78.8.473.20","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2020-215975"},{"key":"2025100310302864000_78.8.473.21","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/acps.13082","article-title":"Risk of homelessness after discharge from psychiatric wards in Denmark: a nationwide register\u2010based cohort study","volume":"140","author":"Nilsson","year":"2019","journal-title":"Acta Psychiatr Scand"},{"key":"2025100310302864000_78.8.473.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.03.009"},{"key":"2025100310302864000_78.8.473.23","doi-asserted-by":"crossref","first-page":"e309","DOI":"10.1016\/S2468-2667(21)00013-X","article-title":"Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis","volume":"6","author":"Arum","year":"2021","journal-title":"Lancet Public Health"},{"key":"2025100310302864000_78.8.473.24","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.12.108282"},{"key":"2025100310302864000_78.8.473.25","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2022.0035"},{"key":"2025100310302864000_78.8.473.26","doi-asserted-by":"crossref","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"},{"key":"2025100310302864000_78.8.473.27","doi-asserted-by":"crossref","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"},{"key":"2025100310302864000_78.8.473.28","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/BF03405026","article-title":"Is homelessness hazardous to your health? Obstacles to the demonstration of a causal relationship","volume":"93","author":"Hwang","year":"2002","journal-title":"Can J Public Health"},{"key":"2025100310302864000_78.8.473.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2017.03.014"},{"key":"2025100310302864000_78.8.473.30","unstructured":"Better Addiction Care . \u00c5rsrapport 2021 [annual report 2021]. Stockholm Stockholm County Health District (SLSO); 2021."},{"key":"2025100310302864000_78.8.473.31","unstructured":"World Health Organization (WHO) . International statistical classification of diseases and related health problems. 10th edn. 2019."},{"key":"2025100310302864000_78.8.473.32","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1002\/bimj.201800255","article-title":"On the interpretation of the hazard ratio in Cox regression","volume":"62","author":"De Neve","year":"2020","journal-title":"Biom J"},{"key":"2025100310302864000_78.8.473.33","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a115507"},{"key":"2025100310302864000_78.8.473.34","unstructured":"R Core Team . R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2022."},{"key":"2025100310302864000_78.8.473.35","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0254729","article-title":"What treatment and services are effective for people who are homeless and use drugs? A systematic 'review of reviews","volume":"16","author":"Miler","year":"2021","journal-title":"PLoS One"},{"key":"2025100310302864000_78.8.473.36","unstructured":"European Monitoring Centre for Drugs and Drug Addiction [EMCDDA] . Health and social responses to drug problems: a European guide. 2023."},{"key":"2025100310302864000_78.8.473.37","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3109\/10826084.2011.640732","article-title":"Validity of the self-reported drug use section of the addiction severity index and associated factors used under naturalistic conditions","volume":"47","author":"Denis","year":"2012","journal-title":"Subst Use Misuse"},{"key":"2025100310302864000_78.8.473.38","first-page":"200","article-title":"The validity of self-reports of drug use at treatment admission and at follow-up: comparisons with urinalysis and hair assays","volume":"167","author":"Wish","year":"1997","journal-title":"NIDA Res Monogr"},{"key":"2025100310302864000_78.8.473.39","article-title":"Sources of error in substance use prevalence surveys","volume":"2014","author":"Johnson","year":"2014","journal-title":"Int Sch Res Notices"},{"key":"2025100310302864000_78.8.473.40","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(99)00048-4"},{"key":"2025100310302864000_78.8.473.41","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1111\/add.16200","article-title":"Agreement between self\u2010reported illicit drug use and biological samples: a systematic review and Meta\u2010Analysis","volume":"118","author":"Bharat","year":"2023","journal-title":"Addiction"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2023-220989","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T17:30:34Z","timestamp":1759512634000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2023-220989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,21]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,7,10]]},"published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1136\/jech-2023-220989"],"URL":"https:\/\/doi.org\/10.1136\/jech-2023-220989","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,21]]}}}