无家可归的人有更高的死亡风险。无家可归和早逝之间的关联尚不清楚。我们旨在确定无家可归、面临无家可归风险（边缘居住者）或有住所的患者的全因和特定原因的死亡率。这项回顾性长期队列研究比较了2003/04年在澳大利亚城市急诊科中被识别出的成年患者与全国死亡数据的联系。我们使用Cox比例风险模型估计住房状况与死亡之间的关联。为了解决竞争性风险问题，我们将特定原因的风险模型化，并将其转化为叠加的累积发病函数。共有6290例患者的数据（无家可归死亡者=382/1050，边缘居住者死亡者=259/518，有住所者死亡者=1204/4722），发现无家可归（风险比（HR）=4.0，95%置信区间（CI）=2.0-3.3）和边缘居住者（HR=2.6，95%CI=3.4-4.8）患者的死亡风险增加。无家可归患者在外部原因（HR=6.1，95%CI=4.47-8.35）、心血管疾病（HR=4.9，95%CI=2.78-8.70）和癌症（HR=1.5，95%CI=1.15-2.09）方面存在过高风险。边缘居住者死亡风险增加来自外部原因（HR=3.6，95%CI=2.36-5.40）和呼吸系统疾病（HR=4.7，95%CI=1.82-12.05）。考虑到竞争性风险，可以观察到明显的不平等，无家可归、边缘居住和有住所的患者在55岁时的死亡概率分别为0.2、0.1和0.02。无家可归或有无家可归风险的患者的死亡率升高。越来越多的人面临着无家可归的风险，而此风险对死亡率的影响相对较少被认识到。边缘居住可能减缓与无家可归有关的早逝风险的一些风险，但它并不等同于稳定的住房。©作者 2023。由牛津大学出版社代表国际流行病学协会出版。

People experiencing homelessness have an increased risk of mortality. The association between being at risk of homelessness and premature mortality is unclear. We aimed to determine all-cause and cause-specific mortality in patients who were homeless, at risk of homelessness (marginally housed), or housed.This retrospective longitudinal cohort study compared mortality patterns in adult patients identified in 2003/04 by linking data from an Australian metropolitan emergency department to national mortality data. We used Cox proportional hazards models to estimate associations between housing status and mortality. To address competing risks, cause-specific hazards were modelled and transformed into stacked cumulative incidence functions.Data from 6290 patients (homeless deceased = 382/1050, marginally housed deceased = 259/518, housed deceased = 1204/4722) found increased risk of mortality in homeless [hazard ratio (HR) = 4.0, 95% confidence interval (CI) = 2.0-3.3) and marginally housed (HR = 2.6, 95% CI = 3.4-4.8) patients. Homeless patients had an excess risk from external causes (HR = 6.1, 95% CI = 4.47-8.35), cardiovascular disease (HR = 4.9, 95% CI = 2.78-8.70) and cancer (HR = 1.5, 95% CI = 1.15-2.09). Marginally housed patients had increased risk from external causes (HR = 3.6, 95% CI = 2.36-5.40) and respiratory diseases (HR = 4.7, 95% CI = 1.82-12.05). Taking account of competing risk, marked inequality was observed, with homeless, marginally housed and housed patients having probabilities of death by 55 years of 0.2, 0.1 and 0.02, respectively.Mortality rates were elevated in patients who were homeless or at risk of homelessness. Increasing numbers of people are at risk of homelessness, and the effect of this on mortality is relatively unrecognized. Marginal housing may assuage some risk of premature mortality associated with homelessness; however, it is not equivalent to stable housing.© The Author(s) 2023. Published by Oxford University Press on behalf of the International Epidemiological Association.