Homelessness is an independent risk factor for mortality
Although the higher mortality risk associated with homelessness can partly be explained by an increased prevalence of morbidity, homelessness itself confers an additional risk, a retrospective cohort study has shown.
A total of 6,323 homeless adults and an age- and sex-matched random sample of 12,451 controls from the local population in Greater Glasgow NHS Board area were studied.
Over the duration of the five-year study, 1.7% (209/12,451) of the general population and 7.2% (457/6,323) of the homeless cohort died, giving homelessness a crude mortality ratio of 4.5. The mean age at death among homeless people was 41 years and among controls it was 53 years. After adjustment for age, sex and morbidity, homelessness remained an independent risk factor for death with an adjusted hazard ratio (HR) of 1.6.
Homelessness had differential effects on cause-specific mortality. For patients who had been previously hospitalised for drug-associated conditions the HR was 7.2 for risk of death from drugs but for those hospitalised for alcohol-related problems it was only 0.7 for risk of death from alcohol misuse.
Although it has been known that homelessness is associated with increased mortality, previous research had not established whether or not this was related solely to the high levels of morbidity in homeless people, which includes high rates of alcohol and drug misuse and mental health problems.
In this study, homelessness itself has been shown to be an independent risk factor for the high mortality seen in this group. In addition to interventions addressing morbidity in homeless people, intensive targeted social interventions directed to homelessness itself may be needed to lower mortality in this highly disadvantaged social group.
Morrison DS. Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. Int J Epidemiol 2009;1–7Reviewer
Dr Jez Thompson
GP and Clinical Director, NHS Hull Social Inclusion Services