Marcel Slockers

33 Health status of homeless people measured by mortality rates life table decomposition method developed by Arriaga. 29 This method partitions the total difference in life expectancy between two populations or time periods into age-specific con- tributions. The method takes into account the effect of a difference in mortality in a specific age group on the number of person-years in that age group and in all older age groups. The Arriaga method is frequently used to decompose differences in life expectancy. Confidence intervals (CIs) for the contributions by age were calculated using parametric bootstrap, assuming a Poisson distribution around the observed mortality rates. This method gives problems if the observed number is zero (the variance is then also zero) as was the case for homeless women aged 20–30 years. Therefore, we added results for remaining life expectancy at age 30 years. The program for decomposition of life and health expectancy 30 is available from the authors on request. Results Mortality in the homeless cohort The present cohort includes 2096 homeless adults aged ≥ 20 years in 2001. Table 1 presents their characteristics: there were 1846 men and 250 women with a mean age of 40.6 years. A total of 17,619 person-years were observed, with a mean follow-up of 8.4 years. In total, 265 homeless persons (232 men and 33 women) died during follow-up. Table 2 presents the number of person-years, deaths and mortality rates of the homeless men and women by age. Within the homeless population, increasing age was associated with an increase in mortality risk (p<0.001). After correction for age, being female was not associated with mortality within this cohort (p=0.55); the RR for males vs. females was 1.12 (95% CI 0.77–1.61). The interaction between age and sex was not significant (p=0.12). The effect of type of service used (only day care services, convalescence care, other), corrected for age and sex was borderline significant (p=0.074). Relative to persons using day care only in 2001, persons using convalescence care (and possibly other services) had a 70% higher mortality rate (RR 1.73, 95% CI 1.04–2.88).