Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England.

Abstract

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group).Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0). The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600). The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512).Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.

Comparing the Impact of Primary Care Practice Design in Two Inner City UK Homelessness Services

“…6 The need for monitoring of health outcomes and collection of routine surveillance data to help implement this is stressed. 3,5 A recent national study in mainstream general practice found that patients with a higher number of LTCs were found to be at increased risk of missing GP appointments, especially patients with diagnosed mental health conditions.…”

Homeless persons' experiences of health‐ and social care: A systematic integrative review

“…Older persons (>50) experiencing homelessness have multiple health problems that remain unaddressed by healthcare services, often lack social support and do not explicitly express their own healthcare needs (van Dongen et al, ), resulting in higher use of acute care. The excess mortality associated with considerable social exclusion, such as homelessness, is extreme (Aldridge et al, ; Fazel, Geddes, & Kushel, ; Slockers, Nusselder, Rietjens, & van Beeck, ), that is, the mortality rate is nearly eight times higher than the average for men and 12 times higher for women (Aldridge et al, ), with an average age for death at 52 years.…”

Prevalence of mental disorders among people who are homeless: an umbrella review

“…This global burden of homelessness has critical implications for health policymaking and practice. In homelessness, the rate of mortality is nearly eight times higher than the average for men and 12 times higher for women, with an average age for death at 52 years (Aldridge et al, 2019(Aldridge et al, , 2018. This can be attributable to the fact that homeless individuals experience enormous health inequalities and have a higher prevalence of various medical conditions (Omerov et al, 2020).…”