Objective To examine mortality in a representative nationwide sample of homeless and marginally housed people living in shelters, rooming houses, and hotels. Design Follow-up study. Setting Canada 1991-2001. Participants 15 100 homeless and marginally housed people enumerated in 1991 census. Main outcome measures Age specific and age standardised mortality rates, remaining life expectancies at age 25, and probabilities of survival from age 25 to 75. Data were compared with data from the poorest and richest income fifths as well as with data for the entire cohort Results Of the homeless and marginally housed people, 3280 died. Mortality rates among these people were substantially higher than rates in the poorest income fifth, with the highest rate ratios seen at younger ages. Among those who were homeless or marginally housed, the probability of survival to age 75 was 32% (95% confidence interval 30% to 34%) in men and 60% (56% to 63%) in women. Remaining life expectancy at age 25 was 42 years (42 to 43) and 52 years (50 to 53), respectively. Compared with the entire cohort, mortality rate ratios for men and women, respectively, were 11.5 (8.8 to 15.0) and 9.2 (5.5 to 15.2) for drug related deaths, 6.4 (5.3 to 7.7) and 8.2 (5.0 to 13.4) for alcohol related deaths, 4

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Area-based deprivation indices (ABDIs) have become a common tool with which to investigate the patterns and magnitude of socioeconomic inequalities in health. ABDIs are also used as a proxy for individual socioeconomic status. Despite their widespread use, comparably less attention has been focused on their geographic variability and practical concerns surrounding the Modifiable Area Unit Problem (MAUP) than on the individual attributes that make up the indices. Although scale is increasingly recognized as an important factor in interpreting mapped results among population health researchers, less attention has been paid specifically to ABDI and scale. In this paper, we highlight the effect of scale on indices by mapping ABDIs at multiple census scales in an urban area. In addition, we compare self-rated health data from the Canadian Community Health Survey with ABDIs at two census scales. The results of our analysis confirm the influence of spatial extent and scale on mapping population health-with potential implications for health policy implementation and resource distribution.KEYWORDS Deprivation indices, MAUP, Population health, Scale. A BRIEF BIOGRAPHY OF POPULATION HEALTH INDICES COMMONLY USED IN CANADAThe use of census data to quantify socioeconomic deprivation is a generally wellaccepted method of identifying populations with poorer health outcomes.1-5 The history of census-based area deprivation indices dates back to at least until 1971, when the Department of the Environment (DOE) in the United Kingdom used data taken from the census to identify localities where a high proportion of households were exposed to adverse social and economic conditions. 6 The indices were developed to more effectively identify areas in need of resources to improve quality of life. Publications stemming from The Black Report, 7 the Whitehall, 8 and Acheson studies 9 launched additional public scrutiny of the relationship between socioeconomic gradients and health status. These studies have spurred a relatively new yet increasingly popular framework that uses socioeconomic data taken from the census to quantify deprivation and demonstrate its relationship with population health. 2,[10][11][12][13][14] Schuurman, Bell, and Oliver are with the

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Healthcare, support workers and public health policy should recognize the important impact of affordable and sustainable housing on the health of persons living with HIV.