Population-Level Health Effects of Involuntary Displacement of People Experiencing Unsheltered Homelessness Who Inject Drugs in US Cities
Author:
Barocas Joshua A.1, Nall Samantha K.1, Axelrath Sarah2, Pladsen Courtney3, Boyer Alaina3, Kral Alex H.4, Meehan Ashley A.5, Savinkina Alexandra6, Peery David7, Bien Michael8, Agnew-Brune Christine9, Goldshear Jesse10, Chiang Joey11, Linas Benjamin P.12, Gonsalves Gregg6, Bluthenthal Ricky N.13, Mosites Emily5, Wortley Pascale14, Todd Jeff14, Melton David14, Flynn Colin14, German Danielle14, Klevens Monina14, Doherty Rose14, O'Cleirigh Conall14, Jimenez Antonio14, Clyde Thomas14, Poe Jonathon14, Vaaler Margaret14, Deng Jie14, Al-Tayyib Alia14, Shodell Danielle14, Higgins Emily14, Griffin Vivian14, Sanger Corrine14, Khuwaja Salma14, Lopez Zaida14, Padgett Paige14, Kwa Sey Ekow14, Ma Yingbo14, Santacruz Hugo14, Brantley Meredith14, Mathews Christopher14, Marr Jack14, Spencer Emma14, Nixon Willie14, Forrest David14, Anderson Bridget14, Tate Ashley14, Abrego Meaghan14, Robinson William T.14, Barak Narquis14, Beckford Jeremy M.14, Braunstein Sarah14, Rivera Alexis14, Carrillo Sidney14, Ibrahim Abdel R.14, Wogayehu Afework14, Moraga Luis14, Brady Kathleen A.14, Shinefeld Jennifer14, Nnumolu Chrysanthus14, Menza Timothy W.14, Orellana E. Roberto14, Bhattari Amisha14, Flynn Anna14, Chambers Onika14, Ramos Marisa14, McFarland Will14, Lin Jessica14, Miller Desmond14, Miranda De Leon Sandra14, Rolon-Colon Yadira14, Martinez Maria P.14, Jaenicke Tom14, Glick Saral14, Kienzle Jennifer14, Smith Brandie14, Reid Toyah14, Opoku Jenevieve14, Kuo Irene14, Adams Monica14, Baugher Amy14, Broz Dita14, Burnett Janet14, Chambers Susan14, Chapin-Bardales Johanna14, Denning Paul14, Finlayson Teresa14, Handanagic Senad14, Hickey Terence14, Kanny Dafna14, Lee Kathryn14, Lewis Rashunda14, Morris Elana14, Olansky Evelyn14, Robbins Taylor14, Sionean Catlainn14, Smith Amanda14, Teplinskaya Anna14, Trujillo Kindsay14, Wejnert Cyprian14, Whiteman Ari14, Xia Mingjing14,
Affiliation:
1. University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora 2. Colorado Coalition for the Homeless, Denver 3. National Health Care for the Homeless Council, Nashville, Tennessee 4. RTI International, Berkeley, California 5. Centers for Disease Control and Prevention, Office of the Deputy Director for Infectious Diseases, Atlanta, Georgia 6. Yale School of Public Health, New Haven, Connecticut 7. Miami Coalition to Advance Racial Equity, Miami, Florida 8. National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia 9. Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, Georgia 10. University of Southern California Keck School of Medicine, Department of Population and Public Health Sciences, Los Angeles 11. University of Washington School of Medicine, Internal Medicine, Seattle 12. Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts 13. University of Southern California Keck School of Medicine, Department of Population and Public Health Sciences and the Institute for Prevention Research, Los Angeles 14. for the NHBS Study Group
Abstract
ImportanceAt least 500 000 people in the US experience homelessness nightly. More than 30% of people experiencing homelessness also have a substance use disorder. Involuntary displacement is a common practice in responding to unsheltered people experiencing homelessness. Understanding the health implications of displacement (eg, “sweeps,” “clearings,” “cleanups”) is important, especially as they relate to key substance use disorder outcomes.ObjectiveTo estimate the long-term health effects of involuntary displacement of people experiencing homelessness who inject drugs in 23 US cities.Design, Setting, and ParticipantsA closed cohort microsimulation model that simulates the natural history of injection drug use and health outcomes among people experiencing homelessness who inject drugs in 23 US cities. The model was populated with city-level data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system and published data to make representative cohorts of people experiencing homelessness who inject drugs in those cities.Main Outcomes and MeasuresProjected outcomes included overdose mortality, serious injection–related infections and mortality related to serious injection–related infections, hospitalizations, initiations of medications for opioid use disorder, and life-years lived over a 10-year period for 2 scenarios: “no displacement” and “continual involuntary displacement.” The population-attributable fraction of continual displacement to mortality was estimated among this population.ResultsModels estimated between 974 and 2175 additional overdose deaths per 10 000 people experiencing homelessness at 10 years in scenarios in which people experiencing homelessness who inject drugs were continually involuntarily displaced compared with no displacement. Between 611 and 1360 additional people experiencing homelessness who inject drugs per 10 000 people were estimated to be hospitalized with continual involuntary displacement, and there will be an estimated 3140 to 8812 fewer initiations of medications for opioid use disorder per 10 000 people. Continual involuntary displacement may contribute to between 15.6% and 24.4% of additional deaths among unsheltered people experiencing homelessness who inject drugs over a 10-year period.Conclusion and RelevanceInvoluntary displacement of people experiencing homelessness may substantially increase drug-related morbidity and mortality. These findings have implications for the practice of involuntary displacement, as well as policies such as access to housing and supportive services, that could mitigate these harms.
Publisher
American Medical Association (AMA)
Cited by
27 articles.
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