CAUSES OF DEATH IN HOMELESS ADULTS IN BOSTON

Background: Homeless persons have high mortality rates, Objective: To ascertain causes of death in a group of homeless persons. Design: Coho rt study. Patients: 17 292 adults seen by the Boston Health Care for t he Homeless Program from 1988 to 1993. Measurements: Cause-specific mo rtality rates adjusted for race and rate ratios that compare mortality rates in homeless persons with those in the general population of Bos ton. Results: Homicide was the leading cause of death among men who we re 18 to 24 years of age (mortality rate, 242.7 per 100 000 person-yea rs; rate ratio, 4.1). The acquired immunodeficiency syndrome was the m ajor cause of death in men (mortality rate, 336.5 per 100 000 person-y ears; rate ratio, 2.0) and women (mortality rate, 116.0 per 100 000 pe rson-years; rate ratio, 5.0) who were 25 to 44 years of age. Heart dis ease and cancer were the leading causes of death in persons who were 4 5 to 64 years of age. Conclusions: The most common causes of death amo ng homeless adults who have contact with clinicians vary by age group. Efforts to reduce the rate of death among homeless persons should foc us on these causes.