Abstract
Homeless-experienced adults have higher liver-related mortality than the general population. The objective of our study was to examine temporal liver-related mortality trends and assess cause-specific liver-related mortality disparities in a large cohort of homeless-experienced adults. We linked a cohort of 60,092 adults who received care at Boston Health Care for the Homeless Program (BHCHP) from 2003-2017 to Massachusetts death occurrence files spanning 2003-2018. We evaluated temporal trends in age-standardized liver-related mortality rates in comparison to the MA population. We identified the leading causes of liver-related death aggregated across the study period and compared these cause-specific mortality rates to the general population, reporting standardized mortality rate ratios (SRRs). Of the 7,130 deaths in the cohort, 652 (9.1%) were liver-related. Among liver-related decedents, the mean age at death was 55.7 years (SD 8.3); 517 (79.2%) were male and 399 (61.2%) were White. Liver-related mortality decreased on average 3.5% annually (95% CI: -6.6%, -0.3%), though remained significantly higher than the MA population throughout the study period. Leading causes of liver-related death were cirrhosis (n=157, SRR 3.2 [95% CI: 3.2, 3.3]), liver cancer (n=148, SRR 2.4 [95% CI: 2.4, 2.5]), alcohol-related liver disease (n=140, SRR 4.4 [95% CI: 4.3, 4.6]), and viral hepatitis (n=99, SRR 7.2 [95% CI: 6.9, 7.6]).Liver-related deaths are an important contributor to excess mortality among homeless-experienced adults. Efforts to reduce this disparity should address alcohol use disorder and viral hepatitis given their substantial contribution to the disparity of mortality in this population.