摘要：Objectives. We compared estimated population-based health outcomes for New York City (NYC) homeless families with NYC residents overall and in low-income neighborhoods. Methods. We matched a NYC family shelter user registry to mortality, tuberculosis, HIV/AIDS, and blood lead test registries maintained by the NYC Department of Health and Mental Hygiene (2001–2003). Results. Overall adult age-adjusted death rates were similar among the 3 populations. HIV/AIDS and substance-use deaths were 3 and 5 times higher for homeless adults than for the general population; only substance-use deaths were higher than for low-income adults. Children who experienced homelessness appeared to be at an elevated risk of mortality (41.3 vs 22.5 per 100 000; P < .05). Seven in 10 adult and child deaths occurred outside shelter. Adult HIV/AIDS diagnosis rates were more than twice citywide rates but comparable with low-income rates, whereas tuberculosis rates were 3 times higher than in both populations. Homeless children had lower blood lead testing rates and a higher proportion of lead levels over 10 micrograms per deciliter than did both comparison populations. Conclusions. Morbidity and mortality levels were comparable between homeless and low-income adults; homeless children's slightly higher risk on some measures possibly reflects the impact of poverty and poor-quality, unstable housing. Most studies examining the health of homeless populations have involved single adults and have identified higher rates of death, tuberculosis (TB), HIV/AIDS, mental health disorders, substance use, poor birth outcomes, and cardiovascular disease than in the general population. 1 – 7 Whether these findings can be generalized to homeless families is not known, as the 2 populations differ greatly. Nationally, homeless families overwhelmingly consist of a young female head of household with children, whereas single homeless adults are mostly men aged 31 to 50 years. 8 Homeless families are also distinct in their reasons for becoming homeless, citing poverty more often and substance use and mental illness less often than is the case for their single adult counterparts. 9 Based on their demographic and socioeconomic profiles, the health of homeless families may be more like that of other low-income families than that of homeless single adults. Recent economic conditions have led to a rise in the number of homeless families nationwide. Although overall US homelessness held fairly constant from 2007 to 2008, the number of homeless families increased by 9%. According to the latest available national data, an estimated 516 700 adults and children were sheltered as families over a 1-year period in 2008, constituting roughly a third of the overall sheltered homeless population during that time. 8 More recent data from a sampling of localities found that, as of September 2009, the count of sheltered families had increased 10% from the previous quarter, as foreclosure and unemployment rates continued to rise. 10 In New York City (NYC), the Department of Homeless Services (DHS) supplies apartment-style shelters and support services such as childcare, housing assistance, and health care referral to homeless families. Because the city provides emergency shelter to eligible families, virtually all homeless families use shelter facilities. In 7 years of an annual count of street homeless, a family has never been found on the street. 11 A small share of homeless families is sheltered by city agencies other than DHS. However, analyses based on DHS shelter registry likely include the vast majority of the NYC homeless family population. Our objective was to systematically characterize the health of adults and children who used the NYC family shelter system. We matched the DHS family shelter registry with 4 health registries managed by the NYC Department of Health and Mental Hygiene, and we compared estimates of morbidity and mortality in the homeless family population with those of the NYC general and lowest-income neighborhood populations.
