Causes of death in homeless adults in Boston

Background: Homeless persons have high mortality rates, Objective: To ascertain causes of death in a group of homeless persons. Design: Cohort study. Patients: 17 292 adults seen by the Boston Health Care for the Homeless Program from 1988 to 1993. Measurements: Cause-specific mortality rates adjusted for race and rate ratios that compare mortality rates in homeless persons with those in the general population of Boston. Results: Homicide was the leading cause of death among men who were 18 to 24 years of age (mortality rate, 242.7 per 100 000 person-years; rate ratio, 4.1). The acquired immunodeficiency syndrome was the major cause of death in men (mortality rate, 336.5 per 100 000 person-years; rate ratio, 2.0) and women (mortality rate, 116.0 per 100 000 person-years; rate ratio, 5.0) who were 25 to 44 years of age. Heart disease and cancer were the leading causes of death in persons who were 45 to 64 years of age. Conclusions: The most common causes of death among homeless adults who have contact with clinicians vary by age group. Efforts to reduce the rate of death among homeless persons should focus on these causes.