Long‐term effects of homelessness on mortality: a 15‐year Australian cohort study

Abstract

Objective: To examine the effect of homelessness on mortality. Methods: This 15-year retrospective longitudinal cohort study compared mortality outcomes of homeless and non-homeless adults attending the emergency department of an innercity public hospital in Melbourne, Victoria between 1 January 2003 and 31 December 2004. Homeless individuals had ≥1 recorded episodes of homelessness within the recruitment period, categorised by type: primary, secondary, tertiary, marginally housed. Non-homeless individuals were stably housed throughout. Results: Over 15 years, homeless individuals had a higher mortality rate (11.89 vs. 8.10 per 1,000 person-years), significantly increased mortality risk (rate ratio 1.47, 95% confidence interval [CI] 1.26-1.71) and younger median age at death (66.60 vs. 78.19 years) compared to non-homeless individuals. Using adjusted Cox proportional hazards models, primary (hazard ratio [HR] 2.05, 95%CI 1.67-2.50), secondary (HR 1.60, 95%CI 1.23-2.10) and tertiary (HR 1.72, 95%CI 1.16-2.56) homelessness were independent risk factors for premature mortality. Conclusion: At least one recorded episode of primary, secondary, or tertiary homelessness was associated with premature mortality and younger age at death over a 15-year period. Implications for public health: Accurately identifying individuals experiencing primary, secondary or tertiary homelessness at the emergency department may enable targeted interventions that could potentially reduce their risk of premature mortality.

The physical and mental health effects of housing homeless people: A systematic review

“…Homelessness is also linked to an increase in morbidity (Nielsen et al, 2011) and multi-morbidity (Bowen et al, 2019), and longitudinal studies (Aldridge et al, 2019;Nordentoft & Wandall-Holm, 2003;Seastres et al, 2020;Stenius-Ayoadeet al, 2017) show that homelessness is associated with higher mortality. For example, the homeless in Copenhagen hostels are four times more likely than the general population to die early (Nordentoft and Wandall-Holm, 2003), while homelessness in Finland is linked to a five-fold increase in mortality (Stenius-Ayoadeet al, 2017).…”

“…For example, the homeless in Copenhagen hostels are four times more likely than the general population to die early (Nordentoft and Wandall-Holm, 2003), while homelessness in Finland is linked to a five-fold increase in mortality (Stenius-Ayoadeet al, 2017). In Australia, homelessness is related with an almost two-fold greater risk of mortality over a 15year period and an approximately 12-year reduction in age at death when compared to non-homeless emergency department attendees (Seastres et al, 2020). When compared to the general population, this is estimated to be a nearly four-fold increase in mortality.…”

Health status and health behaviour of the Hungarian homeless people

“…It is well known that financial deprivation has a strong association with poor health status. People in this vulnerable and isolated situation are particularly affected by health problems which are associated with higher rates of premature mortality [4][5][6][7]. Harsh living conditions, including the street and crowded shelters, increase the risk of infectious diseases like hepatitis C and HIV [8,9], respiratory infections, hepatitis B [10] or different skin infections (pediculosis, scabies) [11].…”

Older women's perceptions of the impact of homelessness on their health needs and their ability to access healthcare

“…Previous research from Australia and internationally has demonstrated that people experiencing homelessness have a high prevalence of a range of physical and mental health conditions that result in high rates of morbidity and mortality 15-17 . The homeless are also known to be less likely to access primary and preventive healthcare services resulting in their health needs being unaddressed until they present as seriously ill with a medical crisis at hospital emergency departments 13,14,18 .…”