title: The effect of local policy actions on mortality among homeless people: a before-after study.
abstract: BACKGROUND
  Homeless people have a 3-5-fold increased risk of mortality compared with general populations. After 2005, policy actions being implemented in Rotterdam, the Netherlands, have improved the living conditions of this group. This study examines the effect of policies aimed at improving living conditions on mortality risks of the homeless.
  
  
  METHODS
  Register-based 10-year follow-up study of homeless in Rotterdam, the Netherlands. The participants are homeless adults (aged 18+ years) who visited one or more services for homeless people in Rotterdam in 2001. The intervention of local policies after 2005 was to get homeless people into housing, increase their participation in employment and other regular daytime activities, and controlling drug and alcohol addictions. The main outcome measure is mortality rate ratios calculated using Poisson regression. Differences in mortality between the periods 2001-05 vs. 2006-10 were assessed.
  
  
  RESULTS
  The cohort of homeless adults in 2001 consisted of 1870 men and 260 women, with a mean age of 40.3 years. During the 10 years of follow-up, 265 persons (232 male and 33 female) died. Adjusted for age and sex, no significant difference in mortality was observed between the periods 2001-05 and 2006-10 (P = 0.9683). A different splitting in periods did not change the results.
  
  
  CONCLUSIONS
  Five years of local policy efforts improved their living conditions, but left the mortality rate of a homeless cohort unchanged. Incomplete reach of the program and long previous histories of homelessness ask for additional policies beyond the provision of housing and other services. Attention to the prevention of homelessness seems needed.
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands slockers@knmg.nl.
authors.forename: Marcel T
authors.initials: MT
authors.lastname: Slockers
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Wilma J
authors.initials: WJ
authors.lastname: Nusselder
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Colette J T
authors.initials: CJ
authors.lastname: Slockers
authors.affiliation: 2 Municipal Public Health Service (GGD) Rotterdam-Rijnmond, GGD Rotterdam-Rijnmond, 3000 LP Rotterdam, The Netherlands.
authors.forename: Luuk
authors.initials: L
authors.lastname: Krol
authors.affiliation: 1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Ed F
authors.initials: EF
authors.lastname: van Beeck
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy / Q000331:legislation & jurisprudence; D006703:Ill-Housed Persons / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D006798:Housing / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011640:Public Policy / Q000331:legislation & jurisprudence*; D012042:Registries; D055815:Young Adult