ArticlePloS one2023
Deaths of profound despair: A retrospective cohort study of mortality among people experiencing homelessness.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 21 citations in OpenAlex.
- A Descriptive Analysis of Suicide Trends by Race/Ethnicity, Sex, and Age Categories in Santa Clara County, California From 2018 to 2023.AJPM focus · 2026Article
- Challenges and opportunities in embedding core components of substance use health care into Housing First programs.Frontiers in public health · 2026Article
- Healthcare access and perceived value of liver screening among people experiencing homelessness and substance use disorders: a qualitative study.BMC health services research · 2025Article
- Mortality and barriers to healthcare among people experiencing homelessness in Paris: a mixed-methods study.International journal for equity in health · 2025Article
- Longitudinal evaluation examining implementation and sustainment of an opioid overdose education and naloxone distribution among veterans who are unstably housed.Implementation science communications · 2025Article
- Improving Health for People Experiencing Homelessness Within and Beyond the VA: From Cancer Screening to Integrated Preventive Health.Annals of family medicine · 2025Article
- Algorithm development for the automation of death certificate analysis and coding.Annals of epidemiology · 2025Article
- Taking care of people experiencing homelessness: a community case study on the practice of the Volunteer Association "A doctor for you" in Brescia, Italy.Frontiers in public health · 2025Article
- "Racial mortality inversion": Black-white disparities in mortality among people experiencing homelessness in the United States.SSM - population health · 2024Article
- Disparities in all-cause mortality among people experiencing homelessness in Toronto, Canada during the COVID-19 pandemic: a cohort study.Frontiers in public health · 2024Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe number of people dying while unhoused is increasing nationally. In Santa Clara County (SCC), deaths of unhoused people have almost tripled in 9 years. This is a retrospective cohort study examining mortality trends among unhoused people in SCC. The objective of the study is to characterize mortality outcomes in the unhoused population, and compare these to the SCC general population. MATERIALS AND
methodsWe obtained data from the SCC Medical Examiner-Coroner's Office on unhoused people's deaths that occurred between 2011-2019. We analyzed demographic trends and cause of death, compared to mortality data on the SCC general population obtained from CDC databases. We also compared rates of deaths of despair.
resultsThere were a total of 974 unhoused deaths in the SCC cohort. The unadjusted mortality rate among unhoused people is higher than the general population, and unhoused mortality has increased over time. The standardized mortality ratio for unhoused people is 3.8, compared to the general population in SCC. The most frequent age of death among unhoused people was between 55-64 years old (31.3%), followed by 45-54 (27.5%), compared to 85+ in the general population (38.3%). Over ninety percent of deaths in the general population were due to illness. In contrast, 38.2% of unhoused deaths were due to substance use, 32.0% illness, 19.0% injury, 4.2% homicide, and 4.1% suicide. The proportion of deaths of despair was 9-fold higher in the unhoused cohort compared to the housed cohort. DISCUSSION: Homelessness has profound impacts on health, as people who are unhoused are dying 20 years younger, with higher rates of injurious, treatable, and preventable causes, than people in the general population. System-level, inter-agency interventions are needed. Local governments need to systematically collect housing status at death to monitor mortality patterns among unhoused people, and adapt public health systems to prevent rising unhoused deaths.
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