Mortality in people experiencing homelessness: a systematic review and meta-analysis.

IF 5.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International journal of epidemiology Pub Date : 2026-08-18 DOI:10.1093/ije/dyag129

James White, Yvonne Moriarty, Mandy Lau, Rebecca Cannings-John, Abigail Palmer, Alison L Weightman, Meg Kiseleva, G David Batty

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引用次数: 0

Abstract

Background: The association between homelessness and the type of homeless experience with all-cause and cause-specific mortality is uncertain.

Methods: Published studies were retrieved through a systematic search of MEDLINE, Embase PsycINFO, and Scopus from inception to December 2024. Unpublished data were identified from open-access data archives. We used random-effects meta-analysis to combine the effect estimates from published and unpublished data from 116 studies comprising 2 563 633 homeless people and 129 292 553 population controls. This review is registered at PROSPERO (CRD42023430984).

Results: The risk of all-cause mortality was increased in people exposed to homelessness compared with those unexposed [relative risk (RR) 2.21, 95% confidence interval (CI) 1.91-2.57, P < .001, I2 = 99.7], with risks similar in men (RR 4.04, 95% CI 2.87-5.21) and women (RR 3.58, 95% CI 2.35-4.82). Risks were higher in people who had slept rough (RR 7.63, 95% CI 3.29-11.97) than in those who had slept in homeless hostels/shelters (RR 3.44, 95% CI 2.10-4.77) and also elevated for people staying in low-cost hotels (RR 5.18, 95% CI 1.14-9.23). Summary RR estimates were elevated for 33 of the 36 (92%) causes of death. The highest risk of death was apparent for psychoactive-substance-use disorder (RR 21.38, 95% CI 14.44-31.67), accidental injuries (RR 13.15, 95% CI 5.46-31.69), and drug overdose (RR 11.65, 95% CI 6.97-19.48). Around half of the studies (57%) were of high quality. No studies were found in low-income countries. There was no evidence of publication bias.

Conclusion: Compared with the general population, homeless people experience an increased risk of premature mortality. The most extreme inequalities were from deaths through psychoactive-substance-use disorder, accidents, and drug overdose. There are evidence-based treatments for psychoactive substance use and drug overdose, suggesting that some of these deaths are avoidable.

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无家可归者的死亡率：系统回顾和荟萃分析。

背景：无家可归和无家可归经历类型与全因死亡率和特定原因死亡率之间的关系是不确定的。方法：通过系统检索MEDLINE、Embase PsycINFO和Scopus，检索自建站至2024年12月的已发表研究。未发表的数据是从开放存取数据档案中识别出来的。我们使用随机效应荟萃分析来结合116项研究中已发表和未发表的数据的效应估计，这些研究包括2563 633名无家可归者和129 292 553名人口对照。本综述在PROSPERO注册（CRD42023430984）。结果：与未暴露者相比，无家可归者的全因死亡风险增加[相对危险度（RR） 2.21, 95%置信区间（CI） 1.91-2.57, P]。结论：与一般人群相比，无家可归者的过早死亡风险增加。最极端的不平等来自于精神活性物质使用障碍、事故和药物过量造成的死亡。有针对精神活性物质使用和药物过量的循证治疗，这表明其中一些死亡是可以避免的。

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

International journal of epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

13.60

自引率

2.60%

发文量

226

审稿时长

3 months

期刊介绍： The International Journal of Epidemiology is a vital resource for individuals seeking to stay updated on the latest advancements and emerging trends in the field of epidemiology worldwide. The journal fosters communication among researchers, educators, and practitioners involved in the study, teaching, and application of epidemiology pertaining to both communicable and non-communicable diseases. It also includes research on health services and medical care. Furthermore, the journal presents new methodologies in epidemiology and statistics, catering to professionals working in social and preventive medicine. Published six times a year, the International Journal of Epidemiology provides a comprehensive platform for the analysis of data. Overall, this journal is an indispensable tool for staying informed and connected within the dynamic realm of epidemiology.