Marcel Slockers

111 General discussion 1. Main findings of this study What is the health status of homeless people as measured by mortality rates? In the prospective cohort study in the period 2001-2010, we found that homelessness is related to high mortality and low life expectancy. We calculated mortality rates adjusted for differences in age and gender (Standardized Mortality Ratios, SMRs), and we found that mortality among homeless people is three and a half times higher than among other inhabitants of Rotterdam (SMR 3.50). Twenty-year-old homeless men and women live 14 and 16 years shorter, respectively, than the general Rotterdam population ( chapter 2 ). The main causes of deathin the cohort were unnatural deaths (26%), cardiovascular diseases (22%), and cancer (17%). Suicides and homicides accounted for 50% of unnatural deaths. There was excess mortality among homeless people for all causes of death. The largest mortality differences to the general Rotterdam population were for unnatural death (SMR 15), infectious diseases (SMR 10) and psychiatric diseases (SMR 8). Among homeless people, mortality from unnatural death was increased for violence (SMR 14), suicide (SMR 14), poisonings (SMR 40), and other accidents (SMR 9) ( chapter 5 ). What is the health status of homeless people measured by health problems presented at the street doctor’s consultation hours? Our analysis of data from the street doctor’s consultation hours in the period 2006-2017 revealed the following: in the street doctor population, the share of psychiatric diagnoses (43%) is the highest, followed by the share of cardiovascular diseases (15%) and endocrine problems (12%). The proportion of hard drug addiction is 17%; the proportion of soft drug addiction is 8%; and the proportion with an alcohol problem as the main diagnosis is 13%. Diabetes (7%) and COPD (5%) are also significant care issues in this population. The proportion of patients with mental health problems and trauma is higher at the street doctor’s consultation hours than in a regular GP practice ( chapter 3 ). What have been the effects of the 2006-2010 Action Plan for Social Support on the health status of homeless people in Rotterdam, as measured by mortality rates and health problems presented at the street doctor's consultation hours? After the implementation of theAction Plan for Social Support during the period 2006-2010, we did not see significant changes in the overall mortality of homeless people ( chapter 4 ). However, we found a significant halving in mortality from intentional injuries (homicide and suicide) after the implementation of these measures ( chapter 5 ). Social measures tend to influence the pattern of causes of death among homeless people: fewer deaths from acute causes and more deaths from chronic conditions.