Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]

Robert Aldridge, Dee Menezes, Dan Lewer, Michelle Cornes, Hannah Evans, Ruth Blackburn, Richard Byng, Mike Clark, Spiros Denaxas, James Fuller, Alan Kilmister, Serena Luchenski, Jill Manthorpe, Martin McKee, Jo Neale, Alaister Story, Michela Tinelli, Martin Whiteford, Fatima Wurie, Andrew Hayward

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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.
Original languageEnglish
Article number4
JournalWellcome Open research
Volume4
Issue number49
Publication statusPublished - 11 Mar 2019

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Peer Review
England
Cause of Death
Hospitalization
Cross-Sectional Studies
Delivery of Health Care
Mortality
Homeless Persons
International Classification of Diseases
Population
Hospital Records
Hospital Mortality
Health

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Aldridge, R., Menezes, D., Lewer, D., Cornes, M., Evans, H., Blackburn, R., ... Hayward, A. (2019). Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]. Wellcome Open research, 4(49), [4].
Aldridge, Robert ; Menezes, Dee ; Lewer, Dan ; Cornes, Michelle ; Evans, Hannah ; Blackburn, Ruth ; Byng, Richard ; Clark, Mike ; Denaxas, Spiros ; Fuller, James ; Kilmister, Alan ; Luchenski, Serena ; Manthorpe, Jill ; McKee, Martin ; Neale, Jo ; Story, Alaister ; Tinelli, Michela ; Whiteford, Martin ; Wurie, Fatima ; Hayward, Andrew. / Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]. In: Wellcome Open research. 2019 ; Vol. 4, No. 49.
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title = "Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]",
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.",
author = "Robert Aldridge and Dee Menezes and Dan Lewer and Michelle Cornes and Hannah Evans and Ruth Blackburn and Richard Byng and Mike Clark and Spiros Denaxas and James Fuller and Alan Kilmister and Serena Luchenski and Jill Manthorpe and Martin McKee and Jo Neale and Alaister Story and Michela Tinelli and Martin Whiteford and Fatima Wurie and Andrew Hayward",
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Aldridge, R, Menezes, D, Lewer, D, Cornes, M, Evans, H, Blackburn, R, Byng, R, Clark, M, Denaxas, S, Fuller, J, Kilmister, A, Luchenski, S, Manthorpe, J, McKee, M, Neale, J, Story, A, Tinelli, M, Whiteford, M, Wurie, F & Hayward, A 2019, 'Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]', Wellcome Open research, vol. 4, no. 49, 4.

Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]. / Aldridge, Robert; Menezes, Dee; Lewer, Dan; Cornes, Michelle; Evans, Hannah; Blackburn, Ruth; Byng, Richard; Clark, Mike; Denaxas, Spiros; Fuller, James; Kilmister, Alan; Luchenski, Serena; Manthorpe, Jill; McKee, Martin; Neale, Jo; Story, Alaister; Tinelli, Michela; Whiteford, Martin; Wurie, Fatima; Hayward, Andrew.

In: Wellcome Open research, Vol. 4, No. 49, 4, 11.03.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]

AU - Aldridge, Robert

AU - Menezes, Dee

AU - Lewer, Dan

AU - Cornes, Michelle

AU - Evans, Hannah

AU - Blackburn, Ruth

AU - Byng, Richard

AU - Clark, Mike

AU - Denaxas, Spiros

AU - Fuller, James

AU - Kilmister, Alan

AU - Luchenski, Serena

AU - Manthorpe, Jill

AU - McKee, Martin

AU - Neale, Jo

AU - Story, Alaister

AU - Tinelli, Michela

AU - Whiteford, Martin

AU - Wurie, Fatima

AU - Hayward, Andrew

N1 - Query to author re request to be removed as an author ET 14/10/19 Not validated in meantime re disclaim Message no longer visible - validated output with note to author. ET 18/10/19 Acceptance in SAN (note from author) ^Requested acceptance ET 18/10/19

PY - 2019/3/11

Y1 - 2019/3/11

N2 - 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.

AB - 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.

M3 - Article

VL - 4

IS - 49

M1 - 4

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Aldridge R, Menezes D, Lewer D, Cornes M, Evans H, Blackburn R et al. Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]. Wellcome Open research. 2019 Mar 11;4(49). 4.