The Use of High-Risk Criteria to Assess Mortality Risk among Unsheltered Homeless Persons

• Published in: Journal of health care for the poor and underserved Vol. 31; no. 1; pp. 441 - 454
• Main Authors: Roncarati, Jill S, O'Connell, James J, Hwang, Stephen W, Baggett, Travis P, Cook, E. Francis, Krieger, Nancy, Sorensen, Glorian
• Format: Journal Article
• Language: English
• Published: United States Johns Hopkins University Press 01.01.2020
• Subjects: Acquired immune deficiency syndrome; Addictions; Adolescent; Adult; Adults; Age; Age Factors; Aged; AIDS; Boston - epidemiology; Cause of Death; Chronic Disease - mortality; Cirrhosis; Cohort analysis; Cohort Studies; Comorbidity; Confidence intervals; Criteria; Drug Overdose - mortality; Drug use; Emergency medical services; Emergency services; Ethnicity; Female; Frostbite; Health care; Health risks; Health services; High risk; HIV; Homeless people; Homeless Persons; Homelessness; Human immunodeficiency virus; Humans; Hypothermia; Inpatient care; Kaplan-Meier Estimate; Kidney diseases; Liver cirrhosis; Liver diseases; Male; Medicine; Middle Aged; Morbidity; Mortality; Mortality rates; Mortality risk; Patient admissions; Population; Public health; Renal failure; Risk Assessment; Risk Factors; Risk groups; Submerging; Survival analysis; Wounds and Injuries - mortality; Young Adult; Boston; United States > US; Massachusetts
• ISSN: 1049-2089; 1548-6869; 1548-6869
• DOI: 10.1353/hpu.2020.0032

We assessed the ability of high-risk criteria developed by Boston Health Care for the Homeless Program to identify increased mortality during a 10-year cohort study (January 2000-December 2009) of 445 unsheltered adults. To qualify as high-risk for mortality, an individual slept unsheltered for six consecutive months or longer plus had one or more of the following characteristics: tri-morbidity, defined as co-occurring medical, psychiatric, and addiction diagnoses; one or more inpatient or respite admissions; three or more emergency department visits; 60 years old or older; HIV/AIDS; cirrhosis; renal failure; frostbite, hypothermia, or immersion foot. A total of 119 (26.7%) individuals met the high-risk criteria. The remaining 326 individuals in the cohort were considered lowerrisk. During the study, 134 deaths occurred; 52 (38.8%) were among high-risk individuals. Compared with sheltered individuals, the age-standardized mortality ratio for the high-risk group was 4.0 (95% confidence interval 3.0, 5.2) times higher and for the lower-risk group was 2.2 (1.8, 2.8) times higher. The hazard ratio, a measure of survival, for the high-risk group was 1.7 (1.2, 2.4) times that of the lower-risk group. High-risk criteria predicted an increased likelihood of mortality among unsheltered individuals. The lower-risk group also had high mortality rates compared with sheltered individuals.