Marcel Slockers

80 Chapter 5 Table 3. Mortality in a Dutch homeless cohort after (2006–2010) vs. before (2001–2005) implementing social policy measures Hazard Ratio 2006–2010 vs. 2001–2005 (95% CI) P value Infectious diseases 0.51 (0.15–1.76) 0.28 Cancer 0.51 (0.15–1.76) 0.51 Psychiatric disorders 2.44 (0.66–9.09) 0.16 Cardiovascular diseases 1.39 (0.81–2.39) 0.23 Respiratory diseases 0.84 (0.30–2.32) 0.73 Gastrointestinal diseases 2.17 (0.78–6.07) 0.12 Other diseases a 0.48 (0.24–0.99) 0.04* Unnatural death b 0.68 (0.41–1.12) 0.12 Accidental poisoning 0.84 (0.32–2.19) 0.83 Other accidents c 1.10 (0.42–2.90) 0.84 Intentional injury 0.45 (0.20–0.98) 0.03* Suicide 0.53 (0.23–1.22) 0.12 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.* P values < 0.05. Discussion In a Dutch homeless cohort, the three main causes of deathwere unnatural death, cardio- vascular diseases and cancer. Compared to the general population of Rotterdam homeless people had an excess risk of death for all causes. The largest mortality differences with non-homeless citizens were observed for unnatural death, infectious diseases and psychiatric disorders. Unnatural causes were responsible for one quarter of all deaths among homeless people, i.e. a much larger share than in the general population of Rotterdam. The mortality due to intentional injuries, which caused one half of all unnatural deaths, differed signifi- cantly between the two study periods: after vs. before the implementation of social policy measures. Our finding that homeless people had an excess risk of for all causes is in line with findings reported in a review about descriptive epidemiology of the health of homeless people. 1 This review further showed causes of excessive mortality to be infections (HIV,