Marcel Slockers

129 Summary Summary Mortality, health problems and access to care for homeless people In chapter 1 we provide an overview of what the concept of homelessness means and how often it occurs. According to the CBS (Dutch Bureau for Statistics), homeless people are people without a fixed regular residence. This chapter describes the two research questions: • What is the health status of homeless people in Rotterdam, measured in terms of mortality rates and health problems as presented at the street doctor’s consultancy hours? • What have been the impacts of recent policy measures such as the Action Plan for Social Support (2006-2010) and changes in health insurance policiy (2015) on the health of homeless people and accessibility of care, respectively. In chapter 2 we describe the mortality and life expectancy in homeless men and women in Rotterdam: 2001-2010. Data on mortality among homeless people are limited. Therefore, this study aimed to describe mortality patterns within a cohort of homeless adults in Rotterdam (the Netherlands) and to assess excess mortality as compared to the general population in that city. Based on 10-year follow-up of homeless adults aged ≥ 20 years who visited services for homeless people in Rotterdam in 2001, and on vital statistics, we assessed the association of mortality with age, sex and type of service used (e.g. only day care, convalescence care, other) within the homeless cohort, and also compared mortality between homeless people and general population using Poisson regression. Life tables and decomposition methods were used to examine differences in life expectancy. During follow-up, of the 2096 adult homeless 265 died. Among homeless people, at age 30 years no significant sex differences were found in overall mortality rates and life expectancy. Compared with the general Rotterdam population, mortality rates were 3.5 times higher in the homeless cohort. Excess mortality was larger in women (rate ratio [RR] 5.56, 95% CI 3.95-7.82) as compared to men (RR 3.31, 95% CI 2.91-3.77), and decreased with age (RR 7.67, 95% CI 6.87-8.56 for the age group 20-44 and RR 1.63, 95% CI 1.41-1.88 for the age group 60+ years). Life expectancy at age 30 years was 11.0 (95% CI 9.1-12.9) and 15.9 (95% CI 10.3-21.5) years lower for homeless men and women compared to men and women in the general population respectively. Homeless adults face excessive losses in life expectancy, with greatest disadvantages among homeless women and the younger age groups.