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.
Highlights
Homelessness has increased by 165% since 2010 in England[1] and our recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries[2,3,4]
In this paper we report on the contribution of different causes of death to overall mortality in homeless people using specialist integrated homeless health and care (SIHHC) services, and compare these to the IMD5 group who were living in areas of high social deprivation
In an unweighted analysis that compared the SIHHC group to the Office for National Statistics (ONS) homeless causes of death analysis, accidents and Discussion Our study investigated causes of death in a large group of homeless people admitted to hospital
Summary
Homelessness has increased by 165% since 2010 in England[1] and our recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries[2,3,4]. Studies of mortality in homeless people often use relative measures such as standardised mortality ratios (SMRs), which are typically highest for death due to violence, suicide and drug overdoses. The use of relative measures may understate the importance of causes of death such as respiratory disease, cardiovascular disease and cancer; which are common in the general population but may be more common among homeless people. 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.
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