Differences in Risks for Recurrent Injury and Death Among Survivors of Violence by Homeless Status

Area of Science:

• Public Health
• Trauma Surgery
• Health Services Research

Background:

• Survivors of violence experiencing homelessness face unique challenges and elevated risks.
• Effective interventions require a clear understanding of the specific dangers encountered by this vulnerable population.

Purpose of the Study:

• To compare the risks of death and reinjury between unhoused and housed survivors of violent injuries.
• To inform the development of targeted interventions for homeless survivors of violence.

Main Methods:

• Retrospective cohort study of patients with violent penetrating injuries presenting to Boston Medical Center Emergency Department (2009-2018).
• Housing status (housed vs. unhoused) was determined at the time of injury.
• Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for mortality and violent reinjury within 3 years.

Main Results:

• Of 2330 patients, 415 (17.8%) were unhoused. Within 3 years, 319 (13.9%) experienced violent reinjury and 55 (2.4%) died.
• Unhoused patients had significantly higher risks of violent reinjury from all causes (HR=1.39), stab wounds (HR=2.34), and blunt assault (HR=1.52).
• While overall mortality was similar, unhoused patients had greater risks of death by homicide (HR=2.89) and drug/alcohol overdose (HR=2.86).

Conclusions:

• Unhoused survivors of violence are at significantly increased risk for recurrent violent injuries and specific causes of death, including homicide and overdose.
• These findings underscore the critical need for stable housing and integrated addiction treatment services for homeless survivors of violence.
• Addressing housing instability and substance use is essential for reducing mortality and morbidity in this high-risk population.