Causes of death among homeless people: A population-based cross-sectional study of linked hospitalisation and mortality data in england. [version 1; peer review: 2 approved]

Robert W. Aldridge*, Dee Menezes, Dan Lewer, Michelle Cornes, Hannah Evans, Ruth Blackburn, Richard Byng, Michael Clark, Spiros Denaxas, James Fuller, Nigel Hewett, Alan Kilmister, Serena Luchenski, Jill Manthorpe, Martin McKee, Joanne Neale, Alistair Story, Michela Tinelli, Martin Whiteford, Fatima WurieAndrew Hayward

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)

Abstract

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group). Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0). The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600). The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.

Original languageEnglish
Article number49
JournalWellcome Open Research
Volume4
DOIs
Publication statusPublished - 2019

Bibliographical note

Funding Information:
[206602]. This study was supported by the National Institute for Health Research (NIHR), [Project number: 13/156/10 to HS & DR]. We also acknowledge the support from the Health Data Research (HDR) UK which receives its funding from HDR UK Ltd funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. ACH’s salary is provided by Central and North West London NHS Community Trust. AS is funded by UCLH Foundation Trust. DL is funded by the NIHR [DRF-2018-11-ST2-016]. JN is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King 焀s College London. RBl is supported by a UK Research and Innovation Fellowship funded by a grant from the Medical Research Council [MR/S003797/1]. MW is part funded by Liverpool Clinical Commissioning Group. SL is funded by NIHR [ICA-CDRF-2016-02-042]. This article is based on independent research commissioned and funded by the NIHR Health Service and Delivery Programme. The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Wellcome Trust, the Department of Health and Social Care, Public Health England or its arm’s length bodies or other government departments.

Funding Information:
This work was supported by the Wellcome Trust through a Clinical Research Career Development Fellowship to RWA [206602]. This study was supported by the National Institute for Health Research (NIHR), [Project number: 13/156/10 to HS & DR]. We also acknowledge the support from the Health Data Research (HDR) UK which receives its funding from HDR UK Ltd funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. ACH?s salary is provided by Central and North West London NHS Community Trust. AS is funded by UCLH Foundation Trust. DL is funded by the NIHR [DRF-2018-11-ST2-016]. JN is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. RBl is supported by a UK Research and Innovation Fellowship funded by a grant from the Medical Research Council [MR/S003797/1]. MW is part funded by Liverpool Clinical Commissioning Group. SL is funded by NIHR [ICA-CDRF-2016-02-042]. This article is based on independent research commissioned and funded by the NIHR Health Service and Delivery Programme. The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Wellcome Trust, the Department of Health and Social Care, Public Health England or its arm?s length bodies or other government departments.

Funding Information:
This article is based on independent research commissioned and funded by the NIHR Health Service and Delivery Programme. The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Wellcome Trust, the Department of Health and Social Care, Public Health England or its arm’s length bodies or other government departments.

Funding Information:
This work was supported by the Wellcome Trust through a Clinical Research Career Development Fellowship to RWA [206602].

Funding Information:
This study was supported by the National Institute for Health Research (NIHR), [Project number: 13/156/10 to HS & DR]. We also acknowledge the support from the Health Data Research (HDR) UK which receives its funding from HDR UK Ltd funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. ACH’s salary is provided by Central and North West London NHS Community Trust. AS is funded by UCLH Foundation Trust. DL is funded by the NIHR [DRF-2018-11-ST2-016]. JN is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. RBl is supported by a UK Research and Innovation Fellowship funded by a grant from the Medical Research Council [MR/S003797/1]. MW is part funded by Liverpool Clinical Commissioning Group. SL is funded by NIHR [ICA-CDRF-2016-02-042].

Publisher Copyright:
© 2019 Aldridge RW et al.

Keywords

  • Amenable mortality
  • Data linkage
  • Homeless health
  • Homeless healthcare
  • Hospital discharge
  • Mortality

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