Excess mortality among people in homelessness with substance use disorders: a Swedish cohort study.

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Epidemiology and Community Health Pub Date : 2024-07-10 DOI:10.1136/jech-2023-220989

Sophie Nadia Gaber, Johan Franck, Härje Widing, Jonas Hällgren, Elisabet Mattsson, Jeanette Westman

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: Mortality was increased for people in homelessness (HR 2.30; 95% CI 1.70 to 3.12) and precarious housing (HR 1.23; 95% CI 0.86 to 1.75) compared with those in stable housing. The association between homelessness and mortality decreased (HR 1.27; 95% CI 0.91 to 1.78) after adjusting for narcotic use (HR 1.28; 95% CI 1.00 to 1.63), intravenous drug use (HR 1.98; 95% CI 1.52 to 2.58) and inpatient care for SUDs (HR 1.96; 95% CI 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% CI 10.2 to 17.9), and 3.7 times higher in people in stable housing with SUDs (SMR=3.7; 95% CI 3.2 to 4.1).

Conclusion: 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.

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患有药物使用障碍的无家可归者死亡率过高：一项瑞典队列研究。

背景：无家可归者罹患药物使用障碍（SUD）和不良健康后果的风险增加。这项队列研究旨在调查无家可归者与 SUD 患者死亡率之间的关系，并对年龄、性别、麻醉品使用情况、静脉注射毒品使用情况和 SUD 住院治疗情况进行调整：瑞典斯德哥尔摩地区国家成瘾护理质量登记处的数据用于分析基线时 SUD 患者（人数=8397）的死亡风险，其中包括 637 名无家可归者、1135 名住房条件不稳定者和 6625 名住房条件稳定者。采用 Cox 回归计算 HRs 和 CIs：无家可归者（HR 2.30；95% CI 1.70 至 3.12）和住房不稳定者（HR 1.23；95% CI 0.86 至 1.75）的死亡率高于住房稳定者。在对麻醉品使用（HR 1.28；95% CI 1.00 至 1.63）、静脉注射毒品（HR 1.98；95% CI 1.52 至 2.58）和 SUDs 住院治疗（HR 1.96；95% CI 1.57 至 2.45）进行调整后，无家可归与死亡率之间的关系有所下降（HR 1.27；95% CI 0.91 至 1.78）。标准化死亡率（SMRs）显示，无家可归且有药物依赖者的死亡率是普通人群的13.6倍（SMR=13.6；95% CI 10.2至17.9），而有稳定住房且有药物依赖者的死亡率是普通人群的3.7倍（SMR=3.7；95% CI 3.2至4.1）：结论：无家可归会增加死亡率，但在对麻醉品使用、静脉注射毒品使用和 SUD 住院治疗进行调整后，风险会降低。需要采取干预措施来降低无家可归者中患有药物依赖性疾病者的死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Epidemiology and Community Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

11.10

自引率

0.00%

发文量

100

审稿时长

3-6 weeks

期刊介绍： The Journal of Epidemiology and Community Health is a leading international journal devoted to publication of original research and reviews covering applied, methodological and theoretical issues with emphasis on studies using multidisciplinary or integrative approaches. The journal aims to improve epidemiological knowledge and ultimately health worldwide.