Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death

BMC Public Health

Matthieu Cantiello¹  Owen Taylor¹  Mohamed Boucekine¹  Sandrine Loubiere²  Pascal Auquier²  Aurélie Tinland³  Vincent Girard⁴ 

[1] Aix-Marseille University, School of medicine – La Timone Medical Campus, EA 3279: CEReSS – Health Service Research and Quality of Life Center, F-13005, Marseille, France;Aix-Marseille University, School of medicine – La Timone Medical Campus, EA 3279: CEReSS – Health Service Research and Quality of Life Center, F-13005, Marseille, France;Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France;Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France;Aix-Marseille University, School of medicine – La Timone Medical Campus, EA 3279: CEReSS – Health Service Research and Quality of Life Center, F-13005, Marseille, France;Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France;Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France;

关键词: Mortality;    Homelessness;    Housing first;    Schizophrenia;    Bipolar disorders;    Health inequalities;   

DOI  :  10.1186/s12889-021-11310-w

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY