Open AccessLong‐term effects of homelessness on mortality: a 15‐year Australian cohort study
Author(s) -
Seastres Ramon Jose,
Hutton Jennie,
Zordan Rachel,
Moore Gaye,
Mackelprang Jessica,
Kiburg Katerina V.,
Sundararajan Vijaya
Publication year - 2020
Publication title -
australian and new zealand journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.946
H-Index - 76
eISSN - 1753-6405
pISSN - 1326-0200
DOI - 10.1111/1753-6405.13038
Subject(s) - medicine , hazard ratio , confidence interval , demography , emergency department , cohort , retrospective cohort study , proportional hazards model , cohort study , mortality rate , young adult , pediatrics , gerontology , psychiatry , sociology
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 inner‐city 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.