Marcel Slockers

79 Changes in the causes of death of homeless people in Rotterdam Table 2. Standardized Mortality Ratios (SMR) of deaths of homeless persons (Rotterdam, 2001–2010) compared to the general Rotterdam population by cause of death. SMR (95% CI) Infectious diseases 10.0 (5.2–17.5) Cancer 2.0 (1.5–2.7) Psychiatric disorders 7.7 (4.0–13.5) Cardiovascular diseases 3.7 (2.8–4.7) Respiratory diseases 3.7-(2.0–6.0) Gastrointestinal diseases 6.6 (4.0–10.4) Other diseases a 3.0 (2.1–4.2) Unnatural death b 14.8 (11.5–18.7) Accidental poisoning 40.2 (23.8–63.6) Other accidents c 9.2 (5.3–14.7) Intentional injury 14.4 (10.2–20.1) Suicide (9.2–20.9) a. Mainly unpecified or ill-defined disorders (50%), endocrine diseases (20%) and neurologic diseases (20%). b. Unnatural death includes unintentional injuries (accidental poisoning and other accidents) and intentional injuries (suicide and homicide). c. Other accidents: all accidents other than poisoning combined, e.g. traffic accidents, accidental falls, accidental drowning, burns. We found an excess risk of death for intentional injury (SMR 14.4, CI 10. 0–20.1), suicide (SMR 14.2, CI 9.2–20.9) accidental poisoning (SMR 40.2, CI 23.8–63.6) and other accidents (SMR 9.2, CI 5.4–14.7). After the implementation of social policy measures in 2006 the mortality rates of most specific causes of death did not differ significantly as compared to the period before 2006 with the exception of intentional injury mortality (Hazard Ratio 0.45, CI 0.20–0.97) and mortality due to other diseases (Hazard ratio 0.48, CI 0.24–0.99) (table 3). When looking separately at suicide a non-significant change in mortality before and after 2006 could be established [Hazard Ratio 0.53 (0.23–1.22), p 0.12].