Explaining excess morbidity amongst homeless shelter users: A multivariate analysis for the Danish adult population

TY - JOUR

T1 - Explaining excess morbidity amongst homeless shelter users

T2 - A multivariate analysis for the Danish adult population

AU - Benjaminsen, Lars

AU - Birkelund, Jesper Fels

PY - 2020/6/1

Y1 - 2020/6/1

N2 - AIMS: This article analyses excess morbidity amongst homeless shelter users compared to the general Danish population. The study provides an extensive control for confounding and investigates to what extent excess morbidity is explained by homelessness or other risk factors.METHODS: Data set includes administrative micro-data for 4,068,926 Danes who were 23 years or older on 1 January 2007. Nationwide data on shelter use identified 14,730 individuals as shelter users from 2002 to 2006. Somatic diseases were measured from 2007 to 2011 through diagnosis data from hospital discharges. The risk of somatic diseases amongst shelter users was analysed through a multivariate model that decomposed the total effect into a direct effect and indirect effects mediated by other risk factors.RESULTS: The excess morbidity associated with shelter use is substantially lower than in studies that did not include an extensive control. Approximately 80% of excess morbidity amongst shelter users is attributed to other risk factors. A large part of the excess morbidity is explained by substance abuse problems and lack of employment, whilst mental illness, low income, low education, civil status and ethnic minority background explain only a limited part. However, when conducting an extensive control for confounding, a significantly higher morbidity was identified amongst shelter users for infectious diseases, lung, skin, blood and digestive diseases, injuries, and poisoning.CONCLUSIONS: Ill health amongst homeless shelter users is widely explained by substance abuse problems and other risk factors. Nonetheless, for many diseases homelessness poses an additional risk to the health.

AB - AIMS: This article analyses excess morbidity amongst homeless shelter users compared to the general Danish population. The study provides an extensive control for confounding and investigates to what extent excess morbidity is explained by homelessness or other risk factors.METHODS: Data set includes administrative micro-data for 4,068,926 Danes who were 23 years or older on 1 January 2007. Nationwide data on shelter use identified 14,730 individuals as shelter users from 2002 to 2006. Somatic diseases were measured from 2007 to 2011 through diagnosis data from hospital discharges. The risk of somatic diseases amongst shelter users was analysed through a multivariate model that decomposed the total effect into a direct effect and indirect effects mediated by other risk factors.RESULTS: The excess morbidity associated with shelter use is substantially lower than in studies that did not include an extensive control. Approximately 80% of excess morbidity amongst shelter users is attributed to other risk factors. A large part of the excess morbidity is explained by substance abuse problems and lack of employment, whilst mental illness, low income, low education, civil status and ethnic minority background explain only a limited part. However, when conducting an extensive control for confounding, a significantly higher morbidity was identified amongst shelter users for infectious diseases, lung, skin, blood and digestive diseases, injuries, and poisoning.CONCLUSIONS: Ill health amongst homeless shelter users is widely explained by substance abuse problems and other risk factors. Nonetheless, for many diseases homelessness poses an additional risk to the health.

KW - Faculty of Social Sciences

KW - homelessness

KW - shelter use

KW - somatic diseases

KW - substance abuse problems

KW - regression decomposition

KW - Denmark

U2 - 10.1177/1403494818759839

DO - 10.1177/1403494818759839

M3 - Journal article

C2 - 29528774

SN - 1403-4948

SP - 1403494818759839

JO - Scandinavian Journal of Public Health

JF - Scandinavian Journal of Public Health

ER -