RISK-FACTORS FOR DEATH IN HOMELESS ADULTS IN BOSTON

Background: Homeless individuals experience high mortality rates. Male s, whites, and substance abusers are more likely to die, but other hig h-risk characteristics are unknown. Objective: To identify demographic and clinical factors associated with an increased risk of death in ho meless individuals. Methods: We conducted a case-control study of 558 adults who were seen by a health care program for the homeless in Bost on, Mass, and who died in 1988 to 1993. Age-matched paired controls we re selected from among individuals seen by the program who were alive at the end of 1993. Predictive data were obtained by blinded review of medical records. Odds ratios (ORs) for death were calculated using lo gistic regression analysis models. Results: In a multivariate analysis , the strongest risk factors for death were acquired immunodeficiency syndrome (OR, 55.8), symptomatic human immunodeficiency virus infectio n (OR, 17.7), asymptomatic human immunodeficiency virus infection (OR, 4.1), renal disease (OR, 18.4), a history of cold-related injury (OR, 8.0), liver disease (OR, 3.8), and arrhythmia (OR, 3.3), A history of substance abuse involving injection drugs (OR, 1.6) or alcohol (OR, 1 .5) also increased the risk of mortality. Nonfluency in English was as sociated with a decreased risk of death (OR, 0.4). Conclusions: In a g roup of adults seen by a health care program for the homeless, specifi c medical illnesses were associated with the greatest risk of death. S ubstance abuse alone was less strongly associated with death. Interven tions to reduce mortality among the homeless should focus on individua ls with high-risk characteristics.