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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 1/2018

01-01-2018 | Original Paper

Homelessness as a predictor of mortality: an 11-year register-based cohort study

Authors: Sandra Feodor Nilsson, Thomas Munk Laursen, Carsten Hjorthøj, Merete Nordentoft

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 1/2018

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Abstract

Purpose

The purpose of this study was to examine the association between homelessness and psychiatric disorders, including substance use disorders, on one hand, and cause-specific and all-cause mortality on the other in a high-income country.

Methods

A historical nationwide register-based cohort study of the Danish population from 15 years of age between 2000 and 2011 was conducted. The association between homelessness, psychiatric disorders, and mortality was analysed by Poisson Regression adjusting for important confounders. Standardised mortality ratios (SMRs) were calculated for people with a history of homelessness compared with the general population using direct age-standardisation.

Results

During 51,892,324 person-years of observation, 656,448 died. People with at least one homeless shelter contact accounted for 173,592 person-years with 4345 deaths. The excess mortality in the population experiencing homelessness compared with the general population was reduced by 50% after adjusting for psychiatric diagnoses, including substance use disorders (mortality rate ratio (MRR) for men 3.30, 95% CI 3.18–3.41; women 4.41, 95% CI 4.14–4.71). Full adjustment including physical comorbidity and socioeconomic factors in a sub-cohort aged 15–29 years resulted in an MRR of 3.94 (95% CI 3.10–5.02) compared with the general population. The excess mortality associated with homelessness differed according to psychiatric diagnosis, sex, and cause of death.

Conclusions

A mental health or a substance use disorder combined with homelessness considerably increases the risk of death. However, homelessness is also independently associated with high mortality. Differences in the association between homelessness and mortality in men and women suggest the need for sex-tailored interventions.
Appendix
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Metadata
Title
Homelessness as a predictor of mortality: an 11-year register-based cohort study
Authors
Sandra Feodor Nilsson
Thomas Munk Laursen
Carsten Hjorthøj
Merete Nordentoft
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 1/2018
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-017-1456-z

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