Morbidity and housing status 10 years after shelter use—follow-up of homeless men in Helsinki, Finland

Stenius-Ayoade, Agnes; Haaramo, Peija; Kautiainen, Hannu; Sunikka, Sanna; Gissler, Mika; Wahlbeck, Kristian; Eriksson, Johan G.

doi:10.1093/eurpub/cky038

Cited by 2 publications

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“…Our results support the findings of several authors that homelessness is not only an independent risk factor of mortality, but also a persistent one over time. Stenius-Ayoade followed a large cohort of homeless people after shelter use in Helsinki (mean age: 49.4 years), and showed that 10 years after 52% were deceased, versus 14.6% of the age-matched control group, even if “only” 5% were still homeless [ 30 ]. For survivors, Oppenheimer showed that a history of homelessness (i.e.…”

Section: Discussionmentioning

confidence: 99%

Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death

et al. 2021

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Background Homeless people face large excess mortality in comparison with the general population, but little is known about the effect of housing interventions like Housing First (HF) on their mortality. Aims of the study 1) to explore 2-years mortality among homeless people with severe mental illness (SMI) included in French HF randomized controlled trial (RCT). 2) To examine causes of death among homeless participants. Methods For 703 participants of HF RCT: 353 in experimental group (HF) and 350 in control group (Treatment As Usual - TAU), any proof of life or death and causes of death were collected with a thorough retrospective investigation among relatives, institutions and administrative databases. Data collection took place from March to June 2017. Results 4.8% (n = 34) of the study participants died over the study period. Mean age of death was 40.9 (+/− 11.4) years. The overall 2-years mortality rate was 0.065 in the HF group (n = 23) versus 0.034 in the TAU group (n = 11). Mortality was associated with medications for opioid use disorder in multivariate Cox analysis (HR: 2.37, 95%CI 1.15–5.04, p = 0.025). Those in HF group seem to be more at risk of death compared to TAU group, mainly during the first 6 months of being housed, although the difference did not reach significance (HR: 0.49, 95%CI 0.24–1.01, p = 0.054). Violent deaths occurred in 52.2% of HF group’s deaths versus 18.2% of TAU group’s deaths, this excess being explained by 34.8% (n = 8) deaths by overdoses in HF group versus none in TAU group. Limitations 1) 8.7% (n = 2) people in HF group died before HF intervention but were analyzed in intention-to-treat. 2) No proof of life or death has been found for only 0.6% in HF group (n = 2) but for 9.5% people in TAU group (n = 33) that could be anonymous deaths. 3) Undetermined causes represented 8.7% of deaths in HF group versus 36.4% in TAU group. 4) The small number of events (deaths) in the study population is a limitation for statistical analysis. Conclusions Due to important limitations, we cannot conclude on HF effect on mortality, but our results nevertheless confirm that the vulnerability of long-term homeless people with SMI persists after accessing independent housing. Earlier intervention in the pathways of homelessness should be considered, alongside active specific support for addictions. Trial registration Ethics Committee Sud Mediterrannée V n° 11.050: trial number 2011-A00668–33: 28/07/2011. Clinicaltrials ID NCT01570712: 4/4/2012.

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Section: Discussionmentioning

confidence: 99%

Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death

et al. 2021

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“…Substance use may act both as a cause and consequence of homelessness, 7 , 11 , 12 , 22 and each may compound the other 6 , 10 , 12 , 13 , 22 . Past research has found, for example, that substance use is associated with higher entry rates into and longer durations of homelessness 11 , 23 – 27 . Our understanding of the relationships between homelessness and substance use has been hindered by limitations in past research, including cross-sectional design or crude measures of homelessness and substance use.…”

Section: Introductionmentioning

confidence: 99%

Association of Substance use Characteristics and Future Homelessness among Emergency Department Patients with Drug use or Unhealthy Alcohol Use: Results from a Linked Data Longitudinal Cohort Analysis

et al. 2022

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Background: Homelessness and substance use are intricately related, and both are prevalent among emergency department (ED) patients. This study examined the longitudinal association of substance use characteristics with future homeless shelter entry among ED patients with any drug use or unhealthy alcohol use. Methods: We present results from a longitudinal cohort study of public hospital ED patients who screened positive for drug use or unhealthy alcohol use and who were not homeless at their baseline (index) ED visit. The primary outcome was homeless shelter entry within 12 months of baseline, ascertained in city homeless shelter administrative data. Primary independent variables of interest were alcohol use severity (AUDIT), drug use severity (DAST-10), and types of drugs used, as reported on baseline survey questionnaires. Results:Analyses included 1,210 ED patients. By 12 months following the baseline ED visit, 114 (9.4%) had entered a homeless shelter. Among patients with the most severe problems related to drug use (DAST-10 score 9–10), 40.9% entered a shelter within 12 months. Past shelter use was the strongest predictor of future shelter entry; once adjusting for historic shelter use the relationship of AUDIT and DAST-10 scores with future shelter entry was no longer statistically significant in multivariable models. Conclusions: ED patients with past year drug use or unhealthy alcohol use had relatively high likelihood of future shelter entry. Risk for homelessness should be addressed in future interventions with this population. Findings illustrate the complexity of relationships between substance use and homelessness.

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Morbidity and housing status 10 years after shelter use—follow-up of homeless men in Helsinki, Finland

Abstract: Homeless staying in shelters have high mortality and morbidity and most of those surviving, are in need of support in their everyday lives even years after the shelter period.

Cited by 2 publications

References 18 publications

Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death

Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death

Association of Substance use Characteristics and Future Homelessness among Emergency Department Patients with Drug use or Unhealthy Alcohol Use: Results from a Linked Data Longitudinal Cohort Analysis

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