Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England

Robert W Aldridge^#^{1

2}, Dee Menezes^#¹, Dan Lewer^{1

2

3}, Michelle Cornes⁴, Hannah Evans¹, Ruth M Blackburn¹, Richard Byng⁵, Michael Clark⁶, Spiros Denaxas⁷, James Fuller⁸, Nigel Hewett⁹, Alan Kilmister⁴, Serena Luchenski², Jill Manthorpe⁴, Martin McKee¹⁰, Joanne Neale³, Alistair Story^{2

11}, Michela Tinelli⁶, Martin Whiteford¹², Fatima Wurie¹³, Andrew Hayward²

Affiliations

¹ Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK.
² Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, NW1 2DA, UK.
³ National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK.
⁴ Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK.
⁵ Community and Primary Care Research Group, University of Plymouth, Plymouth, Devon, PL6 8BX, UK.
⁶ Personal Social Services Research Unit, London School of Economics, London, WC2A 2AE, UK.
⁷ Institute of Health Informatics, University College London, London, NW1 2DA, UK.
⁸ NIHR Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK.
⁹ Pathway Charity, Pathway Charity, London, NW1 2PG, UK.
¹⁰ Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
¹¹ Tropical and Infectious Diseases, University College London Hospitals NHS Trust, London, NW1 2PG, UK.
¹² Health Services Research, University of Liverpool, Liverpool, L69 3BX, UK.
¹³ Public Health England, London, NW9 5EQ, UK.

^# Contributed equally.

PMID: 30984881
PMCID: PMC6449792
DOI: 10.12688/wellcomeopenres.15151.1

Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England

Robert W Aldridge et al. Wellcome Open Res. 2019.

. 2019 Mar 11:4:49.

doi: 10.12688/wellcomeopenres.15151.1. eCollection 2019.

Authors

Affiliations

¹ Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK.
² Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, NW1 2DA, UK.
³ National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK.
⁴ Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK.
⁵ Community and Primary Care Research Group, University of Plymouth, Plymouth, Devon, PL6 8BX, UK.
⁶ Personal Social Services Research Unit, London School of Economics, London, WC2A 2AE, UK.
⁷ Institute of Health Informatics, University College London, London, NW1 2DA, UK.
⁸ NIHR Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK.
⁹ Pathway Charity, Pathway Charity, London, NW1 2PG, UK.
¹⁰ Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
¹¹ Tropical and Infectious Diseases, University College London Hospitals NHS Trust, London, NW1 2PG, UK.
¹² Health Services Research, University of Liverpool, Liverpool, L69 3BX, UK.
¹³ Public Health England, London, NW9 5EQ, UK.

^# Contributed equally.

PMID: 30984881
PMCID: PMC6449792
DOI: 10.12688/wellcomeopenres.15151.1

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.

Keywords: amenable mortality; data linkage; homeless health; homeless healthcare; hospital discharge; mortality.

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Conflict of interest statement

Competing interests: NH is medical director, and ACH is a trustee of the Pathway: Healthcare for homeless people charity. AS is Clinical Lead and Manager for Find and Treat.

Figures

**Figure 1.. Study data flows.**
HES, Hospital Episode Statistics; IMD, index of multiple deprivation; NHS, National Health Service; ONS, Office for National Statistics; PDS, Personal Demographics Service; SIHHC, specialist integrated homeless health and care; UCL, University College London.

**Figure 2.. Patient Flow Diagram.**
N=Number of admission which multiple records for individuals, D=Number of deaths, P=number of patients using HES unique identifier.

**Figure 3.. Underlying cause of death across the three comparator groups.**
Note: ONS causes of death estimated. See extended data file 3 for international classification of disease 10 (ICD-10) code lists used for each underlying cause of death.

See this image and copyright information in PMC

Comment in

Housing and homelessness as a health crisis.
The Lancet. The Lancet. Lancet. 2019 Oct 5;394(10205):1206. doi: 10.1016/S0140-6736(19)32267-6. Lancet. 2019. PMID: 31591970 No abstract available.

References

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Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England

Affiliations

Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

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