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

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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.

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Acknowledgements

Supported by the University of Copenhagen, Department of Clinical Medicine.

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Authors and Affiliations

  1. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Sandra Feodor Nilsson & Merete Nordentoft

  2. Copenhagen University Hospital, Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Kildegaardsvej 28, Build. 15, 4th floor, 2900, Hellerup, Denmark

    Sandra Feodor Nilsson, Carsten Hjorthøj & Merete Nordentoft

  3. The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark

    Thomas Munk Laursen

  4. iPSYCH-The LundbeckFoundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark

    Thomas Munk Laursen, Carsten Hjorthøj & Merete Nordentoft

Authors
  1. Sandra Feodor Nilsson
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  3. Carsten Hjorthøj
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  4. Merete Nordentoft
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Correspondence to Sandra Feodor Nilsson.

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Electronic supplementary material

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127_2017_1456_MOESM1_ESM.docx

Adjusted cumulative incidence function (CIF) of all-cause (A–B) and cause-specific mortality (C–F) among people using homeless shelters with and without a psychiatric diagnosis previous to first homeless shelter contact by age at first homeless shelter contact (DOCX 200 KB)

Supplementary material 2 (DOCX 14 KB)

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Feodor Nilsson, S., Laursen, T.M., Hjorthøj, C. et al. Homelessness as a predictor of mortality: an 11-year register-based cohort study. Soc Psychiatry Psychiatr Epidemiol 53, 63–75 (2018). https://doi.org/10.1007/s00127-017-1456-z

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  • DOI: https://doi.org/10.1007/s00127-017-1456-z

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