J White, Y Moriarty, M Lau, R Cannings-John, A Palmer, A L Weightman, M Kiseleva, G D Batty
{"title":"无家可归，无家可归的类型和特定原因的死亡风险：116项研究的系统回顾和荟萃分析，包括2563633名无家可归者和129292553名人口对照。","authors":"J White, Y Moriarty, M Lau, R Cannings-John, A Palmer, A L Weightman, M Kiseleva, G D Batty","doi":"10.1101/2025.04.22.25326193","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Homelessness might increase the risk of premature mortality, but evidence is scarce, imprecise, and is mostly limited to rough sleepers as opposed to more common types of homelessness.</p><p><strong>Methods: </strong>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 Unpublished data were identified from open-access data archives. We used random-effects meta-analysis to combine effect estimates from published and unpublished data. This review is registered at PROSPERO (CRD42023430984).</p><p><strong>Findings: </strong>We included 116 studies from Europe, the USA, South America, Africa, Asia, and Australia. The meta-analysis of all-cause mortality comprised 110,892,271 people (1,618,049 exposed to homelessness). The risk of all-cause mortality was significantly increased in people exposed to homelessness (Relative risk [RR] 2·12 [95% CI 1·91-2·57], p<0·001, I<sup>2</sup>=99·7%), with risks similar in men (3·88, 2·69-5·06) and women (3·46, 2·17-4·70). This risk was most elevated in people who had slept rough (7·63, 3·29-11·97), followed by those who used low-cost hotels (5·18, 1·14-9·23), then hostels (3·44, 2·10-4·77). In analyses of cause-specific mortality (26,291,900 people, 1,202,205 homeless), summary RR estimates were elevated for 33 of the 36 (92%) causes of death and highest for deaths due to psychoactive substance use disorder (21·36, 14·44-31·67), accidental injuries (13·15, 5·46-31·69), drug-overdose (10·80, 6·37-18·31), and those that are alcohol-related (5·93, 1·10-22·04). No evidence of publication bias was detected.</p><p><strong>Interpretation: </strong>Homeless people experience an increased risk of premature mortality across an array of health outcomes. That the most extreme inequities have an interrelated aetiology suggests a cross-sectoral medical, housing, and social care response is required.</p><p><strong>Funding: </strong>The Centre for Homelessness Impact, Health and Care Research Wales, UK Medical Research Council (MR/P023444/1) and the US National Institute on Aging.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045439/pdf/","citationCount":"0","resultStr":"{\"title\":\"Homelessness, type of homelessness, and risk of cause-specific mortality: a systematic review and meta-analysis of 116 studies comprising 2,563,633 homeless people and 129,292,553 population controls.\",\"authors\":\"J White, Y Moriarty, M Lau, R Cannings-John, A Palmer, A L Weightman, M Kiseleva, G D Batty\",\"doi\":\"10.1101/2025.04.22.25326193\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Homelessness might increase the risk of premature mortality, but evidence is scarce, imprecise, and is mostly limited to rough sleepers as opposed to more common types of homelessness.</p><p><strong>Methods: </strong>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 effect estimates from published and unpublished data. This review is registered at PROSPERO (CRD42023430984).</p><p><strong>Findings: </strong>We included 116 studies from Europe, the USA, South America, Africa, Asia, and Australia. The meta-analysis of all-cause mortality comprised 110,892,271 people (1,618,049 exposed to homelessness). The risk of all-cause mortality was significantly increased in people exposed to homelessness (Relative risk [RR] 2·12 [95% CI 1·91-2·57], p<0·001, I<sup>2</sup>=99·7%), with risks similar in men (3·88, 2·69-5·06) and women (3·46, 2·17-4·70). This risk was most elevated in people who had slept rough (7·63, 3·29-11·97), followed by those who used low-cost hotels (5·18, 1·14-9·23), then hostels (3·44, 2·10-4·77). In analyses of cause-specific mortality (26,291,900 people, 1,202,205 homeless), summary RR estimates were elevated for 33 of the 36 (92%) causes of death and highest for deaths due to psychoactive substance use disorder (21·36, 14·44-31·67), accidental injuries (13·15, 5·46-31·69), drug-overdose (10·80, 6·37-18·31), and those that are alcohol-related (5·93, 1·10-22·04). No evidence of publication bias was detected.</p><p><strong>Interpretation: </strong>Homeless people experience an increased risk of premature mortality across an array of health outcomes. That the most extreme inequities have an interrelated aetiology suggests a cross-sectoral medical, housing, and social care response is required.</p><p><strong>Funding: </strong>The Centre for Homelessness Impact, Health and Care Research Wales, UK Medical Research Council (MR/P023444/1) and the US National Institute on Aging.</p>\",\"PeriodicalId\":94281,\"journal\":{\"name\":\"medRxiv : the preprint server for health sciences\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045439/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"medRxiv : the preprint server for health sciences\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1101/2025.04.22.25326193\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"medRxiv : the preprint server for health sciences","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1101/2025.04.22.25326193","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Homelessness, type of homelessness, and risk of cause-specific mortality: a systematic review and meta-analysis of 116 studies comprising 2,563,633 homeless people and 129,292,553 population controls.
Background: Homelessness might increase the risk of premature mortality, but evidence is scarce, imprecise, and is mostly limited to rough sleepers as opposed to more common types of homelessness.
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 effect estimates from published and unpublished data. This review is registered at PROSPERO (CRD42023430984).
Findings: We included 116 studies from Europe, the USA, South America, Africa, Asia, and Australia. The meta-analysis of all-cause mortality comprised 110,892,271 people (1,618,049 exposed to homelessness). The risk of all-cause mortality was significantly increased in people exposed to homelessness (Relative risk [RR] 2·12 [95% CI 1·91-2·57], p<0·001, I2=99·7%), with risks similar in men (3·88, 2·69-5·06) and women (3·46, 2·17-4·70). This risk was most elevated in people who had slept rough (7·63, 3·29-11·97), followed by those who used low-cost hotels (5·18, 1·14-9·23), then hostels (3·44, 2·10-4·77). In analyses of cause-specific mortality (26,291,900 people, 1,202,205 homeless), summary RR estimates were elevated for 33 of the 36 (92%) causes of death and highest for deaths due to psychoactive substance use disorder (21·36, 14·44-31·67), accidental injuries (13·15, 5·46-31·69), drug-overdose (10·80, 6·37-18·31), and those that are alcohol-related (5·93, 1·10-22·04). No evidence of publication bias was detected.
Interpretation: Homeless people experience an increased risk of premature mortality across an array of health outcomes. That the most extreme inequities have an interrelated aetiology suggests a cross-sectoral medical, housing, and social care response is required.
Funding: The Centre for Homelessness Impact, Health and Care Research Wales, UK Medical Research Council (MR/P023444/1) and the US National Institute on Aging.
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