title: Lack of housing, hospital treatment and premature mortality: a cohort study of people in Counties Manukau district.
abstract: OBJECTIVE
  We considered risk factors for mortality in people admitted to Counties Manukau inpatient facilities, who were also identified by medical staff to have insufficient housing.
  
  
  METHODS
  A cohort study of people aged 15 to 75 years admitted to Counties Manukau inpatient facilities were selected between 2002 and 2014, with ICD-10 codes for insufficient housing. Diagnostic records identified people with substance use and other clinical conditions. Mortality records were used to track survival.
  
  
  RESULTS
  During the study period, 1,182 individuals were identified, 126 (10.7%) of whom died during a median follow-up of 5.7 years. Median survival of the cohort was 63.5 years (95% confidence interval (CI): 58.7 to 69.9) which is about 20 years less than the general population. Of the cohort, the strongest associations with premature mortality were among people with cannabis-related disorders (adjusted hazard ratio [aHR] 2.15; 95% CI: 1.10 to 4.22), diabetes (aHR 1.75; 95% CI: 1.05 to 2.93) and Maaori, compared to European and other ethnic groups, except Asian and Pacific (aHR 1.80; 95% CI: 1.14 to 2.85).
  
  
  CONCLUSIONS
  This population has high mortality. Within this group, Māori and people diagnosed with substance use and diabetes are at even higher risk of premature death.
authors.affiliation: Public Health Physician, Counties Manukau District Health Board, Manukau, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: Thornley
authors.affiliation: Associate-Professor of Biostatistics, Section of Epidemiology and Biostatistics, University of Auckland, New Zealand.
authors.forename: Roger
authors.initials: R
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000208:ethnology*; D009520:New Zealand / Q000453:epidemiology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D044465:White People; D055815:Young Adult