Dataset Information

Mortality among the homeless: Causes and meteorological relationships.

ABSTRACT: The homeless constitute a subpopulation particularly exposed to atmospheric conditions, which, in the temperate climate zone, can result in both cold and heat stress leading to the increased mortality hazard. Environmental conditions have become a significant independent risk factor for mortality from specific causes, including circulatory or respiratory diseases. It is known that this group is particularly prone to some addictions, has a shorter life span, its members often die of different causes than those of the general population and may be especially vulnerable to the influence of weather conditions.The retrospective analysis is based on data concerning 615 homeless people, out of which 176 died in the analyzed period (2010-2016). Data for the study was collected in the city of Olsztyn, located in north-east Poland, temperate climatic zone of transitional type. To characterize weather conditions, meteorological data including daily minimum and maximum temperatures and the Universal Thermal Climate Index (UTCI) were used.The average life span of a homeless person was shorter by about 17.5 years than that recorded for the general population. The average age at death of a homeless male was 56.27 years old (SD 10.38), and 52.00 years old (SD 9.85) of a homeless female. The most frequent causes of death were circulatory system diseases (33.80%). A large number of deaths were attributable to smoking (47.18%), whereas a small number was caused by infectious diseases, while a relatively large proportion of deaths were due to tuberculosis (2.15%). Most deaths occurred in the conditions of cold stress (of different intensity). Deaths caused by hypothermia were thirteen-fold more frequently recorded among the homeless than for the general population. A relative risk of death for a homeless person even in moderate cold stress conditions is higher (RR = 1.84) than in thermoneutral conditions.Our results indicate excessive mortality among the homeless as well as the weak and rather typical influence of atmospheric conditions on mortality rates in this subpopulation, except for a greater risk of cold related deaths than in the general population. UTCI may serve as a useful tool to predict death risk in this group of people.

SUBMITTER: Romaszko J

PROVIDER: S-EPMC5739436 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Mortality among the homeless: Causes and meteorological relationships.

Romaszko Jerzy J Cymes Iwona I Dragańska Ewa E Kuchta Robert R Glińska-Lewczuk Katarzyna K

PloS one 20171221 12

<h4>Background</h4>The homeless constitute a subpopulation particularly exposed to atmospheric conditions, which, in the temperate climate zone, can result in both cold and heat stress leading to the increased mortality hazard. Environmental conditions have become a significant independent risk factor for mortality from specific causes, including circulatory or respiratory diseases. It is known that this group is particularly prone to some addictions, has a shorter life span, its members often d ...[more]

PMID: 29267330

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Project description:BACKGROUND:Homeless persons experience excess mortality, but US-based studies on this topic are outdated or lack information about causes of death. To our knowledge, no studies have examined shifts in causes of death for this population over time. METHODS:We assessed all-cause and cause-specific mortality rates in a cohort of 28 033 adults 18 years or older who were seen at Boston Health Care for the Homeless Program from January 1, 2003, through December 31, 2008. Deaths were identified through probabilistic linkage to the Massachusetts death occurrence files. We compared mortality rates in this cohort with rates in the 2003-2008 Massachusetts population and a 1988-1993 cohort of homeless adults in Boston using standardized rate ratios with 95% confidence intervals. RESULTS:A total of 1302 deaths occurred during 90 450 person-years of observation. Drug overdose (n = 219), cancer (n = 206), and heart disease (n = 203) were the major causes of death. Drug overdose accounted for one-third of deaths among adults younger than 45 years. Opioids were implicated in 81% of overdose deaths. Mortality rates were higher among whites than nonwhites. Compared with Massachusetts adults, mortality disparities were most pronounced among younger individuals, with rates about 9-fold higher in 25- to 44-year-olds and 4.5-fold higher in 45- to 64-year-olds. In comparison with 1988-1993 rates, reductions in deaths from human immunodeficiency virus (HIV) were offset by 3- and 2-fold increases in deaths owing to drug overdose and psychoactive substance use disorders, resulting in no significant difference in overall mortality. CONCLUSIONS:The all-cause mortality rate among homeless adults in Boston remains high and unchanged since 1988 to 1993 despite a major interim expansion in clinical services. Drug overdose has replaced HIV as the emerging epidemic. Interventions to reduce mortality in this population should include behavioral health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness.

Project description:BackgroundHomeless people face large excess mortality in comparison with the general population, but little is known about the effect of housing interventions like Housing First (HF) on their mortality.Aims of the study1) to explore 2-years mortality among homeless people with severe mental illness (SMI) included in French HF randomized controlled trial (RCT). 2) To examine causes of death among homeless participants.MethodsFor 703 participants of HF RCT: 353 in experimental group (HF) and 350 in control group (Treatment As Usual - TAU), any proof of life or death and causes of death were collected with a thorough retrospective investigation among relatives, institutions and administrative databases. Data collection took place from March to June 2017.Results4.8% (n = 34) of the study participants died over the study period. Mean age of death was 40.9 (+/- 11.4) years. The overall 2-years mortality rate was 0.065 in the HF group (n = 23) versus 0.034 in the TAU group (n = 11). Mortality was associated with medications for opioid use disorder in multivariate Cox analysis (HR: 2.37, 95%CI 1.15-5.04, p = 0.025). Those in HF group seem to be more at risk of death compared to TAU group, mainly during the first 6 months of being housed, although the difference did not reach significance (HR: 0.49, 95%CI 0.24-1.01, p = 0.054). Violent deaths occurred in 52.2% of HF group's deaths versus 18.2% of TAU group's deaths, this excess being explained by 34.8% (n = 8) deaths by overdoses in HF group versus none in TAU group.Limitations1) 8.7% (n = 2) people in HF group died before HF intervention but were analyzed in intention-to-treat. 2) No proof of life or death has been found for only 0.6% in HF group (n = 2) but for 9.5% people in TAU group (n = 33) that could be anonymous deaths. 3) Undetermined causes represented 8.7% of deaths in HF group versus 36.4% in TAU group. 4) The small number of events (deaths) in the study population is a limitation for statistical analysis.ConclusionsDue to important limitations, we cannot conclude on HF effect on mortality, but our results nevertheless confirm that the vulnerability of long-term homeless people with SMI persists after accessing independent housing. Earlier intervention in the pathways of homelessness should be considered, alongside active specific support for addictions.Trial registrationEthics Committee Sud Mediterrannée V n° 11.050: trial number 2011-A00668-33: 28/07/2011. Clinicaltrials ID NCT01570712 : 4/4/2012.

Project description:ImportancePrevious studies have shown high mortality rates among homeless people in general, but little is known about the patterns of mortality among "rough sleepers," the subgroup of unsheltered urban homeless people who avoid emergency shelters and primarily sleep outside.ObjectivesTo assess the mortality rates and causes of death for a cohort of unsheltered homeless adults from Boston, Massachusetts.Design, setting, and participantsA 10-year prospective cohort study (2000-2009) of 445 unsheltered homeless adults in Boston, Massachusetts, who were seen during daytime street and overnight van clinical visits performed by the Boston Health Care for the Homeless Program's Street Team during 2000. Data used to describe the unsheltered homeless cohort and to document causes of death were gathered from clinical encounters, medical records, the National Death Index, and the Massachusetts Department of Public Health death occurrence files. The study data set was linked to the death occurrence files by using a probabilistic record linkage program to confirm the deaths. Data analysis was performed from May 1, 2015, to September 6, 2016.ExposureBeing unsheltered in an urban setting.Main outcomes and measuresAge-standardized all-cause and cause-specific mortality rates and age-stratified incident rate ratios that were calculated for the unsheltered adult cohort using 2 comparison groups: the nonhomeless Massachusetts adult population and an adult homeless cohort from Boston who slept primarily in shelters.ResultsOf 445 unsheltered adults in the study cohort, the mean (SD) age at enrollment was 44 (11.4) years, 299 participants (67.2%) were non-Hispanic white, and 72.4% were men. Among the 134 individuals who died, the mean (SD) age at death was 53 (11.4) years. The all-cause mortality rate for the unsheltered cohort was almost 10 times higher than that of the Massachusetts population (standardized mortality rate, 9.8; 95% CI, 8.2-11.5) and nearly 3 times higher than that of the adult homeless cohort (standardized mortality rate, 2.7; 95% CI, 2.3-3.2). Non-Hispanic black individuals had more than half the rate of death compared with non-Hispanic white individuals, with a rate ratio of 0.4 (95% CI, 0.2-0.7; P < .001). The most common causes of death were noncommunicable diseases (eg, cancer and heart disease), alcohol use disorder, and chronic liver disease.Conclusions and relevanceMortality rates for unsheltered homeless adults in this study were higher than those for the Massachusetts adult population and a sheltered adult homeless cohort with equivalent services. This study suggests that this distinct subpopulation of homeless people merits special attention to meet their unique clinical and psychosocial needs.

Project description:The interactions between PM2.5 and meteorological factors play a crucial role in air pollution analysis. However, previous studies that have researched the relationships between PM2.5 concentration and meteorological conditions have been mainly confined to a certain city or district, and the correlation over the whole of China remains unclear. Whether spatial and seasonal variations exist deserves further research. In this study, the relationships between PM2.5 concentration and meteorological factors were investigated in 68 major cities in China for a continuous period of 22 months from February 2013 to November 2014, at season, year, city, and regional scales, and the spatial and seasonal variations were analyzed. The meteorological factors were relative humidity (RH), temperature (TEM), wind speed (WS), and surface pressure (PS). We found that spatial and seasonal variations of their relationships with PM2.5 exist. Spatially, RH is positively correlated with PM2.5 concentration in north China and Urumqi, but the relationship turns to negative in other areas of China. WS is negatively correlated with PM2.5 everywhere except for Hainan Island. PS has a strong positive relationship with PM2.5 concentration in northeast China and mid-south China, and in other areas the correlation is weak. Seasonally, the positive correlation between PM2.5 concentration and RH is stronger in winter and spring. TEM has a negative relationship with PM2.5 in autumn and the opposite in winter. PS is more positively correlated with PM2.5 in autumn than in other seasons. Our study investigated the relationships between PM2.5 and meteorological factors in terms of spatial and seasonal variations, and the conclusions about the relationships between PM2.5 and meteorological factors are more comprehensive and precise than before. We suggest that the variations could be considered in PM2.5 concentration prediction and haze control to improve the prediction accuracy and policy efficiency.

Project description:ObjectivesIn the United States, an estimated 553,000 people are homeless on any given night. Few data provide large-scale, contemporary insight with regard to recent patterns of acute illness in this vulnerable population. We evaluated patterns, causes, and outcomes of acute hospitalization among homeless persons compared with a demographics-standardized and risk-standardized nonhomeless cohort.MethodsRetrospective study comparing 185,292 hospitalizations for homeless individuals and 32,322,569 hospitalizations for demographics-standardized nonhomeless individuals between 2007 and 2013 in Massachusetts, Florida, and California. Annual hospitalization rates for homeless persons were calculated and causes of hospitalization were compared with a demographics-standardized nonhomeless cohort. Logistic and linear regression models were used to estimate risk-standardized outcomes.ResultsFrom 2007 to 2013, hospitalizations for the homeless increased in Massachusetts (294 to 420 hospitalizations per 1000 homeless residents), Florida (161 to 240/1000), and California (133 to 164/1000). Homeless patients were on average 46 years of age, often male (76.1%), white (62%), and either uninsured (41.9%) or insured by Medicaid (31.7%). Hospitalizations for homeless persons, compared with demographics-standardized nonhomeless, were more frequently for mental illness and substance use disorder (52% vs. 18%, P<0.001). Homeless compared with risk-standardized nonhomeless individuals had lower in-hospital mortality rates (0.9% vs. 1.2%, P<0.001), longer mean length of stay (6.5 vs. 5.9 d, P<0.001), and lower mean costs per day ($1 535 vs. $1 834, P<0.001).ConclusionsHospitalizations among homeless persons are rising. Despite greater policy and public health focus over the last few decades, mental illness and substance use remain primary drivers of acute hospitalization among homeless adults. Policy efforts should address barriers to the use of ambulatory care services, and behavioral health services in particular, to help reduce acute care use and improve the long-term health of homeless individuals.

Project description:Importance:Cardiovascular disease is a major cause of death among homeless adults, with mortality rates that are substantially higher than in the general population. It is unknown whether differences in hospitalization-related care contribute to these disparities in cardiovascular outcomes. Objective:To evaluate differences in intensity of care and mortality between homeless and nonhomeless individuals hospitalized for cardiovascular conditions (ie, acute myocardial infarction, stroke, cardiac arrest, or heart failure). Design, Setting, and Participants:This retrospective cross-sectional study included all hospitalizations for cardiovascular conditions among homeless adults (n?=?24?890) and nonhomeless adults (n?=?1?827?900) 18 years or older in New York, Massachusetts, and Florida from January 1, 2010, to September 30, 2015. Statistical analysis was performed from February 6 to July 16, 2019. Main Outcomes and Measures:Risk-standardized diagnostic and therapeutic procedure rates and in-hospital mortality rates. Results:Of the 1?852?790 total hospitalizations for cardiovascular conditions across 525 hospitals, 24?890 occurred among patients who were homeless (11?452 women and 13?438 men; mean [SD] age, 65.1 [14.8] years) and 1?827?900 occurred among patients who were not homeless (850?660 women and 977?240 men; mean [SD] age, 72.1 [14.6] years). Most hospitalizations among homeless individuals were primarily concentrated among 11 hospitals. Homeless adults were more likely than nonhomeless adults to be black (38.6% vs 15.6%) and insured by Medicaid (49.3% vs 8.5%). After accounting for differences in demographics (age, sex, and race/ethnicity), insurance payer, and clinical comorbidities, homeless adults hospitalized for acute myocardial infarction were less likely to undergo coronary angiography compared with nonhomeless adults (39.5% vs 70.9%; P?<?.001), percutaneous coronary intervention (24.8% vs 47.4%; P?<?.001), and coronary artery bypass graft (2.5% vs 7.0%; P?<?.001). Among adults hospitalized with stroke, those who were homeless were less likely than nonhomeless individuals to undergo cerebral angiography (2.9% vs 9.5%; P?<?.001) but were as likely to receive thrombolytic therapy (4.8% vs 5.2%; P?=?.28). In the cardiac arrest cohort, homeless adults were less likely than nonhomeless adults to undergo coronary angiography (10.1% vs 17.6%; P?<?.001) and percutaneous coronary intervention (0.0% vs 4.7%; P?<?.001). Risk-standardized mortality was higher for homeless persons with ST-elevation myocardial infarction compared with nonhomeless persons (8.3% vs 6.2%; P?=?.04). Mortality rates were also higher for homeless persons than for nonhomeless persons hospitalized with stroke (8.9% vs 6.3%; P?<?.001) or cardiac arrest (76.1% vs 57.4%; P?<?.001) but did not differ for heart failure (1.6% vs 1.6%; P?=?.83). Conclusions and Relevance:There are significant disparities in in-hospital care and mortality between homeless and nonhomeless adults with cardiovascular conditions. There is a need for public health and policy efforts to support hospitals that care for homeless persons to reduce disparities in hospital-based care and improve health outcomes for this population.

Project description:Airborne pollen causes various types of allergies in humans, and the extent of allergic infection is related to the presence of different types of sporo–pollen and existing meteorological conditions in a certain area. Therefore, an aeropalynological study of 72 airborne samples with a hydrofluoric acid (HF) treatment was conducted in the Haizhu district of Guangzhou, China, in 2016, to identify the temporal variations in airborne sporo–pollen and the relationship between airborne sporo–pollen concentrations and different meteorological variables in Guangzhou, China. Forty-five types of airborne pollen, seven types of airborne spores, and some undetermined sporo–pollen taxa were identified with two separate plant habitats occurring during this period (from January to December 2016): arboreal pollen (tree-based) and non-arboreal pollen (herb, shrub, aquatic, liane, etc.). Furthermore, the daily records of four key meteorological variables (temperature, precipitation, relative humidity, and wind speed) were acquired to distinguish the pollen seasons and correlated with Spearman's rho test to establish a pollen-weather data book with the seasonal variations. The two leading seasons were identified based on pollen abundance: spring and autumn. Among them, the primary dominant sporo–pollen families during the spring season were Poaceae, Pinaceae, Euphorbiaceae, Moraceae, Microlepia sp., and Polypodiaceae. Conversely, Artemisia sp., Asteraceae, Cyperaceae, Poaceae, Alnus sp., Corylus sp., Myrtaceae, and Rosaceae were the dominant pollen species during autumn. However, few pollen grains were identified in January, May–July, and December. The statistical analysis revealed that temperature had both positive and negative correlations with sporo–pollen concentrations. However, precipitation and relative humidity had a strong impact on the sporo–pollen dispersion and exhibited a negative correlation with the sporo–pollen concentrations. The wind speed had a positive but strong correlation with the sporo–pollen concentration during the study period. Some inconsistent results were found due to environmental variations, vegetation type, and climate change around the study area. This study will facilitate the identification of pollen seasons to prevent the occurrence of pollen-related allergies in the Guangzhou city area. Aeropalynology, seasonal variation, climate, bioaerosol, airborne pollen and spore concentration.

Dataset Information

Mortality among the homeless: Causes and meteorological relationships.

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Mortality among the homeless: Causes and meteorological relationships.

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