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. 2013 Oct 2;8(10):e73979.
doi: 10.1371/journal.pone.0073979. eCollection 2013.

Mortality and life expectancy in homeless men and women in Rotterdam: 2001-2010

Wilma J Nusselder  1 , Marcel T Slockers, Luuk Krol, Colette T Slockers, Caspar W N Looman, Ed F van Beeck
Affiliations

Mortality and life expectancy in homeless men and women in Rotterdam: 2001-2010

Wilma J Nusselder et al. PLoS One. .

Abstract

Background: Data on mortality among homeless people are limited. Therefore, this study aimed to describe mortality patterns within a cohort of homeless adults in Rotterdam (the Netherlands) and to assess excess mortality as compared to the general population in that city.

Methods: Based on 10-year follow-up of homeless adults aged ≥ 20 years who visited services for homeless people in Rotterdam in 2001, and on vital statistics, we assessed the association of mortality with age, sex and type of service used (e.g. only day care, convalescence care, other) within the homeless cohort, and also compared mortality between the homeless and general population using Poisson regression. Life tables and decomposition methods were used to examine differences in life expectancy.

Results: During follow-up, of the 2096 adult homeless 265 died. Among the homeless, at age 30 years no significant sex differences were found in overall mortality rates and life expectancy. Compared with the general Rotterdam population, mortality rates were 3.5 times higher in the homeless cohort. Excess mortality was larger in women (rate ratio [RR] RR 5.56, 95% CI 3.95-7.82) as compared to men (RR 3.31, 95% CI 2.91-3.77), and decreased with age (RR 7.67, 95% CI 6.87-8.56 for the age group 20-44 and RR 1.63, 95% CI 1.41-1.88 for the age group 60+ years). Life expectancy at age 30 years was 11.0 (95% CI 9.1-12.9) and 15.9 (95% CI 10.3-21.5) years lower for homeless men and women compared to men and women in the general population respectively.

Conclusion: Homeless adults face excessive losses in life expectancy, with greatest disadvantages among homeless women and the younger age groups.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Contributions of age groups to differences in remaining life expectancies of homeless men and women as compared to the general Rotterdam population of men and women.
Difference in remaining life expectancy (homeless population – Rotterdam population) of men and women, at age 20 years§ decomposed by age group (in years). § For women the contribution below age 30 years is not presented because the number of deaths in homeless women was zero and the confidence intervals could not be obtained in the situation of zero deaths.
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