Marcel Slockers

29 Health status of homeless people measured by mortality rates Introduction Homeless people generally have substantial health disadvantages as compared to the general population. 1-15 . Also, studies on homeless people have reported a high proportion of psychiatric disorders 16 and substance use 2,10 as well as excess mortality related to different types of substance abuse. 2,10 Moreover, homeless people have a higher prevalence of morbidity, and homelessness itself appeared to be an independent risk factor for mortality from specific causes, including drug-related conditions, circulatory diseases and respiratory diseases. 9 Studies have also documented variations in mortality within the homeless population, indicating higher mortality of whites as compared to other racial groups, which differs from that in the general population. 15 Also, among women, only older women retained the usual female survival advantage over their homeless male counter- parts, whereas younger homeless women did not. 3 Only a few countries have investigated (excess) mortality of homeless people and most have been limited by small sample sizes, loss-to-follow-up and uncertain linkage of data. 10 Excluding studies which deal with a specific group of homeless people, e.g. persons in convalescence care, 13,17 persons with mental problems 18-20 or rough sleepers, 12 mortality among homeless people has only been studied in the USA (Philadelphia, 4 Boston, 7,21,22 NewYork, 1 Canada (Toronto, 3,5 Montreal), Denmark (nationwide, 10 Copenhagen, 11 Sweden (Stockholm, 2,18 and the United Kingdom (Glasgow. 9 Of these, only 4 described mortality of homeless cohorts in the 21 st century. 2,9,10,15 Another limitation of earlier studies is that they often exclude the most vulnerable groups, such as those sleeping rough. This study aims to describe mortality patterns by age, sex, and type of service use within a cohort of homeless people and to assess excess mortality as compared to the general population of Rotterdam between 2001 and 2010. The goal was to investigate a com- prehensive selection of the homeless by including homeless people in contact with very diverse types of services, ranging from only meal services to night-care facilities and con- valescence care, and by including services provided by local authorities and by charitable organizations. Based on almost 10 years follow-up, we describe mortality differentials within the homeless cohort, and between homeless people and the general population. Life table decomposition analysis is used to assess to what extent different age groups contributed to the disparity in life expectancy between homeless people and the general population.