Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England.
Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England.
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DOI：
10.12688/wellcomeopenres.15151.1
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发表时间：
2019-01-01
影响因子：
--
通讯作者：
Hayward, Andrew
中科院分区：
文献类型：
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作者：
Aldridge, Robert W;Menezes, Dee;Hayward, Andrew
背景资料：自2010年以来，英格兰的无家可归者增加了165%，许多环境的证据表明，受影响的人死亡率很高。在本文中，我们研究了不同的死亡原因的贡献，无家可归的人最近在英格兰的医院与专业综合无家可归者的健康和护理（SIHHC）计划的整体死亡率。研究方法：我们对2013年11月1日至2016年11月30日期间参加17个SIHHC计划中任何一个的人的相关入院记录和死亡率数据进行了分析。我们的主要结局是死亡，我们在第10版国际疾病分类（ICD-10）特定死亡的亚组中进行了分析;以及可治愈原因的死亡。我们将我们的结果与生活在高度社会剥夺地区（IMD 5组）的人的样本进行了比较。结果：我们收集了3，882名无家可归者住院的数据，这些数据与600例死亡有关。SIHHC的中位死亡年龄为51.6岁（四分位距42.7-60.2），IMD 5的中位死亡年龄为71.5岁（60.67-79.0）。根据ICD-10章节，SIHHC组的前三位潜在死亡原因是外部死亡原因（21.7%; 130/600）、癌症（19.0%; 114/600）和消化系统疾病（19.0%; 114/600）。在无家可归的SIHHC组（181/600）中，在年龄和性别加权后，由于合理原因导致的死亡百分比为30.2%，而在IMD 5组（578/2，512）中为23.0%。结论：近三分之一的无家可归者死亡是由于及时有效的医疗保健。合理死亡的沉重负担凸显了无家可归对健康的极端危害，需要更加重视预防无家可归和早期医疗干预。
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.