title: Mortality from treatable illnesses in marginally housed adults: a prospective cohort study.
abstract: OBJECTIVE
  Socially disadvantaged people experience greater risk for illnesses that may contribute to premature death. This study aimed to evaluate the impact of treatable illnesses on mortality among adults living in precarious housing.
  
  
  METHODS
  A prospective cohort based in a community sample.
  
  
  METHODS
  A socially disadvantaged neighbourhood in Vancouver, Canada.
  
  
  METHODS
  Adults (N=371) living in single room occupancy hotels or recruited from the Downtown Community Court and followed for median 3.8 years.
  
  
  METHODS
  Participants were assessed for physical and mental illnesses for which treatment is currently available. We compared cohort mortality rates with 2009 Canadian rates. Left-truncated Cox proportional hazards modelling with age as the time scale was used to assess risk factors for earlier mortality.
  
  
  RESULTS
  During 1269 person-years of observation, 31/371 (8%) of participants died. Compared with age-matched and sex-matched Canadians, the standardised mortality ratio was 8.29 (95% CI 5.83 to 11.79). Compared with those that had cleared the virus, active hepatitis C infection was a significant predictor for hepatic fibrosis adjusting for alcohol dependence and age (OR=2.96, CI 1.37 to 7.08). Among participants <55 years of age, psychosis (HR=8.12, CI 1.55 to 42.47) and hepatic fibrosis (HR=13.01, CI 3.56 to 47.57) were associated with earlier mortality. Treatment rates for these illnesses were low (psychosis: 32%, hepatitis C virus: 0%) compared with other common disorders (HIV: 57%, opioid dependence: 61%) in this population.
  
  
  CONCLUSIONS
  Hepatic fibrosis and psychosis are associated with increased mortality in people living in marginal conditions. Timely diagnosis and intervention could reduce the high mortality in marginalised inner city populations.
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Andrea A
authors: AA
authors: Jones
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Fidel
authors: F
authors: Vila-Rodriguez
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Olga
authors: O
authors: Leonova
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Verena
authors: V
authors: Langheimer
authors: Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Donna J
authors: DJ
authors: Lang
authors: Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Alasdair M
authors: AM
authors: Barr
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Ric M
authors: RM
authors: Procyshyn
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Geoffrey N
authors: GN
authors: Smith
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Krista
authors: K
authors: Schultz
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Tari
authors: T
authors: Buchanan
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Michael
authors: M
authors: Krausz
authors: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Julio S
authors: JS
authors: Montaner
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: G William
authors: GW
authors: MacEwan
authors: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Alexander
authors: A
authors: Rauscher
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: William J
authors: WJ
authors: Panenka
authors: Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.
authors: Allen E
authors: AE
authors: Thornton
authors: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors: William G
authors: WG
authors: Honer
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D003141:Communicable Diseases / Q000401:mortality; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality; D008297:Male; D001523:Mental Disorders / Q000401:mortality; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000401:mortality; D035862:Vulnerable Populations
keywords: INFECTIOUS DISEASES; PUBLIC HEALTH