Marcel Slockers

76 Chapter 5 The latter was established in a cohort of homeless persons visiting a facility for this group in 2001. Within this cohort we further analyzed the contribution of specific causes of death to the excess mortality of homeless persons and we compared mortality rates among homeless people before and after the implementation of the Dutch social policy measures. This explorative study addressed the following research questions: 1. What is the contribution of specific causes of death to the excess mortality of homeless persons in Rotterdam? 2. Can we identify differences in cause-specific mortality rates before vs. after imple- menting social policy measures in Rotterdam? Methods Study design and population We conducted a register-based 10-year follow-up study of homeless adults (20+), who visited one or more institutions providing care to homeless people in Rotterdam in 2001. Institutions providing services to homeless people ranging from the provision of meals to night care facilities and convalescence care were approached to provide full name, date of birth and sex of persons who visited their facility in 2001. This information was largely available because in 2001 homeless people were counted for research purposes. 17 Both institutions subsidized by the local government and services provided by the church were included, covering services at different locations in Rotterdam. To construct a database for this project on mortality among homeless people we pooled the lists from the different facilities, which yielded 5810 records; removal of duplicates with same name, initials/ surname, date of birth and sex yielded 3398 persons. We used a restrictive matching procedure to ensure that for all matched persons we could determine in the municipal population registers whether (and if so when) that person had died. Of the 3398 persons in our cohort, 2159 provided a match with the municipal population registers (which include information on vital status and date of death). A total of 7 persons had died before the start of the follow-up (leaving 2152). Persons below age 18 were excluded (leaving 2130). Mortality data Data on mortality within this cohort were extracted from the municipal population registers with national coverage, extended with other registries (i.e. from general practice, health insurance and municipal public mental health care). In total 265 homeless persons died between 2001 and 2010. To identify their causes of death, our cohort data were linked