{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:54:58Z","timestamp":1792014898146,"version":"4.4.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DeNardo Foundation"},{"DOI":"10.13039\/100009482","name":"Santa Clara University","doi-asserted-by":"publisher","award":["Faculty Startup Funds"],"award-info":[{"award-number":["Faculty Startup Funds"]}],"id":[{"id":"10.13039\/100009482","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The number of people dying while unhoused is increasing nationally. In Santa Clara County (SCC), deaths of unhoused people have almost tripled in 9 years. This is a retrospective cohort study examining mortality trends among unhoused people in SCC. The objective of the study is to characterize mortality outcomes in the unhoused population, and compare these to the SCC general population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We obtained data from the SCC Medical Examiner-Coroner\u2019s Office on unhoused people\u2019s deaths that occurred between 2011\u20132019. We analyzed demographic trends and cause of death, compared to mortality data on the SCC general population obtained from CDC databases. We also compared rates of <jats:italic>deaths of despair<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There were a total of 974 unhoused deaths in the SCC cohort. The unadjusted mortality rate among unhoused people is higher than the general population, and unhoused mortality has increased over time. The standardized mortality ratio for unhoused people is 3.8, compared to the general population in SCC. The most frequent age of death among unhoused people was between 55\u201364 years old (31.3%), followed by 45\u201354 (27.5%), compared to 85+ in the general population (38.3%). Over ninety percent of deaths in the general population were due to illness. In contrast, 38.2% of unhoused deaths were due to substance use, 32.0% illness, 19.0% injury, 4.2% homicide, and 4.1% suicide. The proportion of deaths of despair was 9-fold higher in the unhoused cohort compared to the housed cohort.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>Homelessness has profound impacts on health, as people who are unhoused are dying 20 years younger, with higher rates of injurious, treatable, and preventable causes, than people in the general population. System-level, inter-agency interventions are needed. Local governments need to systematically collect housing status at death to monitor mortality patterns among unhoused people, and adapt public health systems to prevent rising unhoused deaths.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0281912","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T18:42:56Z","timestamp":1676572976000},"page":"e0281912","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Deaths of profound despair: A retrospective cohort study of mortality among people experiencing homelessness"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5824-7634","authenticated-orcid":true,"given":"Jamie Suki","family":"Chang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Saxton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Bright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle A.","family":"Jorden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy","family":"Gutierrez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"issue":"6","key":"pone.0281912.ref001","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1093\/eurpub\/ckw083","article-title":"Mortality among homeless people in France, 2008\u201310.","volume":"26","author":"C Vuillermoz","year":"2016","journal-title":"The European Journal of Public Health"},{"key":"pone.0281912.ref002","doi-asserted-by":"crossref","DOI":"10.12688\/wellcomeopenres.15151.1","article-title":"Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England.","volume":"4","author":"RW Aldridge","year":"2019","journal-title":"Wellcome open research."},{"issue":"6","key":"pone.0281912.ref003","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/1753-6405.13038","article-title":"Long\u2010term effects of homelessness on mortality: A 15\u2010year Australian cohort study","volume":"44","author":"RJ Seastres","year":"2020","journal-title":"Australian and New Zealand Journal of Public Health"},{"issue":"3","key":"pone.0281912.ref004","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1093\/ije\/dyp160","article-title":"Homelessness as an independent risk factor for mortality: results from a retrospective cohort study","volume":"38","author":"DS Morrison","year":"2009","journal-title":"International journal of epidemiology"},{"key":"pone.0281912.ref005","unstructured":"Moses, J. \/ National Alliance to End Homelessness. 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