Higher Mortality Rates in Homeless, but not in Psychiatrically Ill Adults

In a recently released study, Nielsen et al (2011), identify mortality rates of those who are homeless in Denmark. As one might expect, the rate of mortality in those who are homeless is 5.6 to 6.7 times higher (SMR = 5.6 for men and 6.7 for women) than that of the general population. Death risk was even higher when the individual had a substance abuse problem. However this points out another inequality in society, directly illuminating the health disparities for those most vulnerable. The homeless population is of course more likely to have a psychiatric disorder. In this study 58% of homeless men and 62% of homeless women had a prior psychiatric disorder diagnosis. Most surprising was that those with psychiatric disorders were not at higher mortality risk than those without a psychiatric disorder.


This is quite interesting, as offhand I would think that the psychiatrically ill would be at greater mortality risk when combined with homelessness. This study suggests that the factor of import may be the socioeconomic disparity and vulnerabilities associated with being homeless NOT the mental illness or its treatment (i.e. drug side effects like metabolic syndrome). Of course I will need to more closely review the study and its design… and in Denmark there are wonderful data sources available to be able to determine rates like this in the homeless population. In the US we have a very difficult time trying to determine rates due to the homeless population being disenfranchised from any system of care.

Here is link to a report of the study and the reference for the study too!

http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/27048?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=230719
 
Nielsen SF, et al "Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study" Lancet 2011; DOI: 10.1016/S0140-6736(11)60747-2.
 
JGeddes JR, Fazel S "Extreme health inequalities: Mortality in homeless people" Lancet 2011; DOI: 10.1016/S0140-6736(11)60885-4.