Rxivist logo

Creating an e-cohort of individuals with lived experience of homelessness and subsequent mortality in Wales, UK.

By Jiao Song, Charlotte N.B. Grey, Alisha R Davies

Posted 17 Dec 2020
medRxiv DOI: 10.1101/2020.12.15.20248252

BackgroundHomelessness is an extreme form of social exclusion, with homeless people experiencing considerable social and health inequities. Estimates of morbidity and mortality amongst homeless populations is limited due to the lack of recording of housing status across health datasets. The aim of this study is to: (1) identify a homelessness e-cohort by linking routine health data, and (2) explore whether a period of reported past homelessness, places this population at greater risk of morbidity and mortality. MethodsHomelessness identified through linkage across primary, secondary care, and substance misuse datasets in the Secure Anonymised Information Linkage (SAIL) Databank. Mortality was examined through linkage to the Office for National Statistics mortality data. ResultsE-cohort of 15,472 individuals with lived experience of homelessness identified. Of those, 21 individuals died between February and July 2020 from COVID-19. Those with lived experience of homelessness had increased mortality from many causes including COVID-19, i.e. accidents, liver diseases and suicides. ConclusionLinking multiple routine datasets provides a more comprehensive dataset of a marginalised population. Application of the cohort demonstrated that individuals with lived experience of homelessness have increased mortality from COVID-19 and other causes. The underlying reasons, health needs, and causes of death warrant further exploration. O_TEXTBOXThumbnail Sketch What is already known on this subject? O_LIHomelessness includes the street homeless and other precarious/insecure housing situations (e.g. sofa surfing), and this population suffer multiple health and social inequalities, known to have a detrimental impact on short and longer-term health outcomes C_LIO_LIUnderstanding the health impact resulting from lived experiences of homelessness is limited due to a lack of consistent and accurate definition and recording of homelessness in health and social care datasets C_LIO_LIHomelessness policy in Wales during the COVID-19 pandemic supported the current street homeless, but what less is understood on the impact of those with a period of reported homelessness and insecure housing situations prior to COVID-19 C_LI What this study adds? O_LIThis study has created an e-cohort of 15,472 individuals with lived experience of homelessness recorded by NHS Wales services between since 2014 in Wales, from routinely collected primary care, secondary care, and substance misuse datasets stored in the Secure Anonymised Information Linkage (SAIL) Databank C_LIO_LIThis demonstrates it is possible to link multiple routinely collected health and care datasets to create a reproducible e-cohort that can rapidly be used (prospectively and retrospectively) to support research and policy C_LIO_LIOur methodology allows for a more sensitive definition of those in current and past vulnerable housing circumstances that will allow for improved understanding of health impacts in this group, and inform practice and policy response C_LIO_LIUsing the e-cohort we examined the relationship between homelessness and mortality outcomes during the COVID-19 pandemic and found individuals with lived experience of homelessness, even if resolved, were at greater ongoing risk of mortality. The underlying reasons, health needs, and causes of death in this population warrants further exploration. C_LI C_TEXTBOX

Download data

  • Downloaded 286 times
  • Download rankings, all-time:
    • Site-wide: 158,615
    • In public and global health: 2,310
  • Year to date:
    • Site-wide: 124,247
  • Since beginning of last month:
    • Site-wide: 56,331

Altmetric data


Downloads over time

Distribution of downloads per paper, site-wide


PanLingua

News