Background
Methods
Study sample and data collection
Statistical analyses
Results
Study sample characteristics
Homeless N = 559 | Housed N = 3599 | |||
---|---|---|---|---|
Characteristic | n (%) | n (%) | Chi Square p value | Trend Test p value |
Year of Death | ||||
2002–2004 | 148 (26.48) | 845 (23.48) | 0.3099 | 0.8104 |
2005–2007 | 115 (20.57) | 869 (24.15) | ||
2008–2010 | 103 (18.43) | 646 (17.95) | ||
2011–2013 | 93 (16.64) | 623 (17.31) | ||
2014–2016 | 100 (17.89) | 616 (17.12) | ||
Age at death | ||||
20–29 | 20 (3.58) | 39 (1.08) |
< 0.0001
| |
30–39 | 96 (17.17) | 349 (9.70) | ||
40–49 | 221 (39.53) | 1084 (30.12) | ||
50–59 | 165 (29.52) | 1211 (33.65) | ||
60–69 | 50 (8.94) | 657 (18.26) | ||
70–99 | 7 (1.25) | 259 (7.20) | ||
Race | ||||
Non-Hispanic White | 250 (44.72) | 2227 (61.88) |
< 0.0001
| |
Hispanic | 76 (13.60) | 441 (12.25) | ||
African-American | 196 (35.06) | 686 (19.06) | ||
Other | 37 (6.62) | 245 (6.81) | ||
Transmission Risk Factor | ||||
MSM | 92 (16.46) | 2146 (59.63) |
< 0.0001
| |
MSM-PWID | 205 (36.67) | 789 (21.92) | ||
PWID | 235 (42.04) | 508 (14.12) | ||
Heterosexual | 19 (3.40) | 86 (2.39) | ||
Other | 8 (1.43) | 70 (1.94) | ||
Gender | ||||
Female | 108 (19.32) | 287 (7.97) |
< 0.0001
| |
Male | 411 (73.52) | 3206 (89.08) | ||
Transgender | 40 (7.16) | 106 (2.95) | ||
Poverty at Diagnosis | ||||
Yes | 505 (90.34) | 837 (23.26) |
< 0.0001
| |
No | 54 (9.66) | 2762 (76.74) | ||
Country of Birth | ||||
USA/US Dependency | 502 (89.80) | 3189 (88.61) | 0.4050 | |
Other | 57 (10.20) | 410 (11.39) | ||
County of Residence at Death | ||||
San Francisco | 378 (67.62) | 2253 (62.60) |
0.0220
| |
Other | 181 (32.38) | 1346 (37.40) | ||
AIDS dx prior to death | 483 (86.40) | 3139 (87.22) | 0.5929 | |
Prescribed ART | ||||
Yes | 424 (75.85) | 3024 (84.02) |
< 0.0001
| |
No | 135 (24.15) | 575 (15.98) | ||
First CD4 Count after Diagnosis (Within 6 months) | ||||
CD4 < 200 | 128 (34.32) | 845 (36.84) | 0.1450 | |
CD4 200–499 | 139 (37.27) | 905 (39.45) | ||
CD4 > 500 | 106 (28.42) | 544 (23.71) | ||
Missing data | 186 | 1305 | ||
First Viral Load after Diagnosis (within 6 months) | ||||
Viral load < 401 | 22 (8.33) | 113 (8.96) | 0.7610 | |
Viral load 401–3999 | 46 (17.42) | 207 (16.42) | ||
Viral load 4000-49,999 | 102 (38.64) | 454 (36.00) | ||
Viral load > 49,000 | 94 (35.61) | 487 (38.62) | ||
Missing data | 295 | 2338 |
Causes of deaths by county of residency at time of death
Cause of Death among San Francisco Residents | Cause of Death among Non-San Francisco Residents | ||||
---|---|---|---|---|---|
Cause of Death | N (%) | Trend Test p value | Cause of Death | N (%) | Trend Test p value |
Accidental death (including drug related) |
<.0001
| Accidental death (including drug related) | 0.6497 | ||
2002–2004 | 24 (3.64) | 2002–2004 | 27 (8.11) | ||
2005–2007 | 61 (9.58) | 2005–2007 | 37 (10.66) | ||
2008–2010 | 65 (13.77) | 2008–2010 | 29 (10.47) | ||
2011–2013 | 58 (12.89) | 2011–2013 | 27 (10.15) | ||
2014–2016 | 60 (14.56) | 2014–2016 | 29 (9.54) | ||
AIDS cancer |
< 0.0001
| AIDS cancer | 0.1002 | ||
2002–2004 | 72 (10.91) | 2002–2004 | 33 (9.91) | ||
2005–2007 | 60 (9.42) | 2005–2007 | 19 (5.48) | ||
2008–2010 | 33 (6.99) | 2008–2010 | 29 (10.47) | ||
2011–2013 | 28 (6.22) | 2011–2013 | 20 (7.52) | ||
2014–2016 | 19 (4.61) | 2014–2016 | 15 (4.93) | ||
AIDS opportunistic infections (excluding AIDS cancers) |
< 0.0001
| AIDS opportunistic infections (excluding AIDS cancers) | 0.0639 | ||
2002–2004 | 188 (28.48) | 2002–2004 | 81 (24.32) | ||
2005–2007 | 153 (24.02) | 2005–2007 | 79 (22.77) | ||
2008–2010 | 98 (20.76) | 2008–2010 | 56 (20.22) | ||
2011–2013 | 79 (17.56) | 2011–2013 | 47 (17.67) | ||
2014–2016 | 73 (17.72) | 2014–2016 | 61 (20.07) | ||
Alcohol related liver disease | 0.1152 | Alcohol related liver disease | 0.4591 | ||
2002–2004 | 7 (1.06) | 2002–2004 | 5 (1.50) | ||
2005–2007 | 6 (0.94) | 2005–2007 | 3 (0.86) | ||
2008–2010 | 6 (1.27) | 2008–2010 | 2 (0.36) | ||
2011–2013 | 6 (1.33) | 2011–2013 | 0 (0.00) | ||
2014–2016 | 9 (2.18) | 2014–2016 | 4 (1.32) | ||
Assault | 0.1028 | Assault |
0.0490
| ||
2002–2004 | 3 (0.45) | 2002–2004 | 1 (0.30) | ||
2005–2007 | 5 (0.78) | 2005–2007 | 2 (0.58) | ||
2008–2010 | 3 (0.64) | 2008–2010 | 0 (0.00) | ||
2011–2013 | 6 (1.33) | 2011–2013 | 2 (0.75) | ||
2014–2016 | 5 (1.21) | 2014–2016 | 5 (1.64) | ||
Cardiomyopathy |
0.0080
| Cardiomyopathy | 0.4488 | ||
2002–2004 | 13 (1.97) | 2002–2004 | 7 (2.10) | ||
2005–2007 | 7 (1.10) | 2005–2007 | 9 (2.59) | ||
2008–2010 | 11 (2.33) | 2008–2010 | 7 (2.53) | ||
2011–2013 | 10 (2.22) | 2011–2013 | 4 (1.50) | ||
2014–2016 | 18 (4.37) | 2014–2016 | 5 (1.64) | ||
Cerebral vascular event | 0.1230 | Cerebral vascular event | 0.1221 | ||
2002–2004 | 19 (2.88) | 2002–2004 | 10 (3.00) | ||
2005–2007 | 16 (2.51) | 2005–2007 | 11 (3.17) | ||
2008–2010 | 22 (4.66) | 2008–2010 | 7 (2.53) | ||
2011–2013 | 13 (2.89) | 2011–2013 | 6 (2.26) | ||
2014–2016 | 19 (4.61) | 2014–2016 | 18 (5.92) | ||
COPD | 0.1489 | COPD |
0.0401
| ||
2002–2004 | 37 (5.61) | 2002–2004 | 17 (5.11) | ||
2005–2007 | 48 (7.54) | 2005–2007 | 7 (2.02) | ||
2008–2010 | 39 (8.26) | 2008–2010 | 12 (4.33) | ||
2011–2013 | 28 (6.22) | 2011–2013 | 17 (6.39) | ||
2014–2016 | 36 (8.74) | 2014–2016 | 21 (6.91) | ||
Diabetes | 0.0804 | Diabetes |
0.0003
| ||
2002–2004 | 14 (2.12) | 2002–2004 | 4 (1.20) | ||
2005–2007 | 29 (4.55) | 2005–2007 | 11 (3.17) | ||
2008–2010 | 18 (3.81) | 2008–2010 | 11 (3.97) | ||
2011–2013 | 25 (5.56) | 2011–2013 | 22 (8.27) | ||
2014–2016 | 15 (3.64) | 2014–2016 | 16 (5.26) | ||
HIV/AIDS |
< 0.0001
| HIV/AIDS |
< 0.0001
| ||
2002–2004 | 557 (84.39) | 2002–2004 | 259 (77.78) | ||
2005–2007 | 472 (74.10) | 2005–2007 | 243 (70.03) | ||
2008–2010 | 314 (66.53) | 2008–2010 | 194 (70.04) | ||
2011–2013 | 284 (63.11) | 2011–2013 | 164 (61.65) | ||
2014–2016 | 258 (62.62) | 2014–2016 | 183 (60.20) | ||
Heart disease |
0.0004
| Heart disease |
< 0.0001
| ||
2002–2004 | 132 (20.00) | 2002–2004 | 73 (21.92) | ||
2005–2007 | 128 (20.09) | 2005–2007 | 79 (22.77) | ||
2008–2010 | 132 (27.97) | 2008–2010 | 79 (28.52) | ||
2011–2013 | 99 (22.00) | 2011–2013 | 89 (33.46) | ||
2014–2016 | 121 (29.97) | 2014–2016 | 101 (33.22) | ||
Ischemic |
0.0408
| Ischemic |
0.0494
| ||
2002–2004 | 37 (5.61) | 2002–2004 | 25 (7.51) | ||
2005–2007 | 36 (5.65) | 2005–2007 | 23 (6.63) | ||
2008–2010 | 36 (7.63) | 2008–2010 | 28 (10.11) | ||
2011–2013 | 35 (7.78) | 2011–2013 | 24 (9.02) | ||
2014–2016 | 33 (8.01) | 2014–2016 | 34 (11.18) | ||
Liver disease | 0.0539 | Liver disease | 0.2200 | ||
2002–2004 | 111 (16.82) | 2002–2004 | 52 (15.62) | ||
2005–2007 | 85 (13.34) | 2005–2007 | 41 (11.82) | ||
2008–2010 | 67 (14.19) | 2008–2010 | 37 (13.36) | ||
2011–2013 | 56 (12.44) | 2011–2013 | 30 (11.28) | ||
2014–2016 | 53 (12.84) | 2014–2016 | 37 (12.17) | ||
Mental disorders | 0.2685 | Mental disorders |
0.0035
| ||
2002–2004 | 61 (9.34) | 2002–2004 | 25 (7.51) | ||
2005–2007 | 74 (11.62) | 2005–2007 | 36 (10.37) | ||
2008–2010 | 50 (10.59) | 2008–2010 | 28 (10.11) | ||
2011–2013 | 43 (9.56) | 2011–2013 | 36 (13.53) | ||
2014–2016 | 31 (7.52) | 2014–2016 | 43 (14.14) | ||
Mental disorders due to substance abuse | 0.3142 | Mental disorders due to substance abuse |
0.0061
| ||
2002–2004 | 57 (8.64) | 2002–2004 | 22 (6.61) | ||
2005–2007 | 66 (10.36) | 2005–2007 | 33 (9.51) | ||
2008–2010 | 43 (9.11) | 2008–2010 | 21 (7.58) | ||
2011–2013 | 42 (9.33) | 2011–2013 | 33 (12.41) | ||
2014–2016 | 28 (6.80) | 2014–2016 | 38 (12.50) | ||
Non-AIDS cancer |
< 0.0001
| Non-AIDS cancer |
0.0003
| ||
2002–2004 | 79 (11.97) | 2002–2004 | 31 (9.31) | ||
2005–2007 | 102 (16.01) | 2005–2007 | 47 (13.54) | ||
2008–2010 | 77 (16.31) | 2008–2010 | 43 (15.52) | ||
2011–2013 | 88 (19.56) | 2011–2013 | 49 (18.42) | ||
2014–2016 | 83 (20.15) | 2014–2016 | 56 (18.42) | ||
Overdose |
< 0.0001
| Overdose | 0.3463 | ||
2002–2004 | 18 (2.73) | 2002–2004 | 18 (5.41) | ||
2005–2007 | 47 (7.38) | 2005–2007 | 19 (5.48) | ||
2008–2010 | 56 (11.86) | 2008–2010 | 21 (7.58) | ||
2011–2013 | 51 (11.33) | 2011–2013 | 23 (8.65) | ||
2014–2016 | 50 (12.14) | 2014–2016 | 18 (5.92) | ||
Pancreatitis/ cancer | 0.2176 | Pancreatitis/ cancer | 0.5330 | ||
2002–2004 | 9 (1.36) | 2002–2004 | 2 (0.60) | ||
2005–2007 | 2 (0.31) | 2005–2007 | 1 (0.29) | ||
2008–2010 | 2 (0.42) | 2008–2010 | 3 (1.08) | ||
2011–2013 | 2 (0.44) | 2011–2013 | 0 (0.00) | ||
2014–2016 | 3 (0.73) | 2014–2016 | 1 (0.33) | ||
Pneumonia |
0.0045
| Pneumonia |
0.0264
| ||
2002–2004 | 96 (14.55) | 2002–2004 | 49 (14.71) | ||
2005–2007 | 81 (12.72) | 2005–2007 | 39 (11.24) | ||
2008–2010 | 61 (12.92) | 2008–2010 | 39 (14.08) | ||
2011–2013 | 48 (10.67) | 2011–2013 | 19 (7.14) | ||
2014–2016 | 37 (8.98) | 2014–2016 | 31 (10.20) | ||
Renal | 0.4942 | Renal | 0.4874 | ||
2002–2004 | 84 (12.73) | 2002–2004 | 25 (7.51) | ||
2005–2007 | 65 (10.20) | 2005–2007 | 40 (11.53) | ||
2008–2010 | 48 (10.17) | 2008–2010 | 29 (10.47) | ||
2011–2013 | 46 (10.22) | 2011–2013 | 22 (8.27) | ||
2014–2016 | 48 (11.65) | 2014–2016 | 33 (10.86) | ||
Septicemia | 0.3818 | Septicemia | 0.6743 | ||
2002–2004 | 81 (12.27) | 2002–2004 | 32 (9.61) | ||
2005–2007 | 66 (10.36) | 2005–2007 | 34 (9.80) | ||
2008–2010 | 45 (9.53) | 2008–2010 | 28 (10.11) | ||
2011–2013 | 47 (10.44) | 2011–2013 | 22 (8.27) | ||
2014–2016 | 44 (10.68) | 2014–2016 | 28 (9.21) | ||
Suicide | 0.8411 | Suicide | 0.2143 | ||
2002–2004 | 16 (2.42) | 2002–2004 | 9 (2.70) | ||
2005–2007 | 24 (3.77) | 2005–2007 | 12 (3.46) | ||
2008–2010 | 22 (4.66) | 2008–2010 | 10 (3.61) | ||
2011–2013 | 14 (3.11) | 2011–2013 | 12 (4.51) | ||
2014–2016 | 11 (2.67) | 2014–2016 | 13 (4.28) | ||
Viral hepatitis | 0.0603 | Viral hepatitis | 0.5918 | ||
2002–2004 | 108 (16.36) | 2002–2004 | 50 (15.02) | ||
2005–2007 | 97 (15.23) | 2005–2007 | 39 (10.37) | ||
2008–2010 | 58 (12.29) | 2008–2010 | 32 (11.55) | ||
2011–2013 | 59 (12.89) | 2011–2013 | 31 (11.65) | ||
2014–2016 | 55 (13.35) | 2014–2016 | 39 (12.83) |
Prevalence ratios – multiple causes of death
Outcome | Unadjusted PR (95% CI) for homelessness | Adjusted PR (95% CI) for homelessness |
---|---|---|
Accident (including overdose) (n = 417) |
1.53 (1.20, 1.95)
| 1.11 (0.83, 1.49) |
AIDS cancera (n = 328) | 0.70 (0.48, 1.00) | 0.89 (0.58, 1.35) |
AIDS opportunistic infections (excluding AIDS cancers)a (n = 915) | 1.05 (0.87, 1.26) | |
Alcoholic liver disease (n = 47) | 1.32 (0.62, 2.83) | |
Assault (n = 32) |
2.52 (1.17, 5.44)
| 2.56 (0.90, 7.28) |
Cardiomyopathy (n = 91) | 0.89 (0.47, 1.66) | |
Cerebrovascular disease (n = 141) | 0.71 (0.41, 1.23) | |
COPD (n = 262) | 1.03 (0.72, 1.46) | |
Diabetes (n = 165) |
0.46 (0.25, 0.85)
| 0.60 (0.30, 1.17) |
Heart diseasea (n = 1033) | 0.86 (0.71, 1.04) | |
HIV/AIDSa (n = 2928) | 0.95 (0.85, 1.06) | |
Ischemic heart disease (n = 311) |
0.59 (0.39, 0.88)
| 0.87 (0.55, 1.38) |
Liver disease (n = 569) | 1.21 (0.97, 1.52) | |
Mental disordersa (n = 427) |
2.15 (1.73, 2.78)
|
1.63 (1.24, 2.14)
|
Mental disorders due to substance use (n = 383) |
2.24 (1.79, 2.82)
|
1.70 (1.27, 2.27)
|
Non-AIDS cancera (n = 655) |
0.43 (0.31, 0.59)
|
0.63 (0.44, 0.89)
|
Overdose (n = 321) |
1.57 (1.19, 2.07)
| 1.06 (0.76, 1.47) |
Pancreatic disease (n = 25) | 1.23 (0.42, 3.57) | |
Pneumonia (n = 500) | 1.12 (0.87, 1.43) | |
Renal disease (n = 440) | 1.12 (0.86, 1.45) | |
Septicemia (n = 427) | 1.14 (0.87, 1.48) | |
Suicide (n = 143) | 0.70 (0.40, 1.21) | |
Viral Hepatitis (n = 564) |
1.32 (1.06, 1.65)
| 0.88 (0.68, 1.38) |