title: Migration to the Downtown Eastside neighbourhood of Vancouver and changes in service use in a cohort of mentally ill homeless adults: a 10-year retrospective study.
abstract: OBJECTIVE
  Little research has investigated the role of migration as a potential contributor to the spatial concentration of homeless people with complex health and social needs. In addition, little is known concerning the relationship between possible migration and changes in levels of service use over time. We hypothesised that homeless, mentally ill individuals living in a concentrated urban setting had migrated from elsewhere over a 10-year period, in association with significant increases in the use of public services.
  
  
  METHODS
  Recruitment was concentrated in the Downtown Eastside neighbourhood of Vancouver, Canada.
  
  
  METHODS
  Participants (n=433) met criteria for chronic homelessness and serious mental illness, and provided consent to access administrative data.
  
  
  METHODS
  Linked administrative data were used to retrospectively examine geographic relocation as well as rates of health, justice, and social welfare service utilisation in each of the 10 years prior to recruitment. Generalised estimating equations were used to estimate the effect of migration on service use.
  
  
  RESULTS
  Over a 10-year period there was significant movement into Vancouver's Downtown Eastside neighbourhood (from 17% to 52% of the cohort). During the same period, there were significant annual increases in community medical services (adjusted rate ratio (ARR) per year=1.08; 95% CI 1.06 to 1.10), hospital admissions (ARR=1.08; 95% CI 1.04 to 1.11), criminal convictions (ARR=1.08; 95% CI 1.03 to 1.13), and financial assistance payments (ARR=1.04; 95% CI 1.03 to 1.06). Migration was significantly associated with financial assistance, but not with other types of services.
  
  
  CONCLUSIONS
  Significant increases in service use over a 10-year period coincided with significant migration into an urban area where relevant services were concentrated. These results highlight opportunities for early intervention in spatially diverse neighbourhoods to interrupt trajectories marked by worsening health and extremely high service involvement. Further research is urgently needed to investigate the causal relationships between physical migration, health and social welfare, and escalating use of public services.
  
  
  BACKGROUND
  ISRCTN57595077 and ISRCTN66721740; Post-results.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Stefanie N
authors.initials: SN
authors.lastname: Rezansoff
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D063426:Human Migration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D011632:Public Assistance / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012946:Social Welfare / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: MENTAL HEALTH