Health, mortality and migration: A 15-year follow-up cohort of persons experiencing homelessness

Abstract

This study examined the health status and mortality of a cohort of persons experiencing homelessness (PEH) over a fifteen-year period in Girona, Spain. A prospective analysis was conducted on a cohort of 855 PEH from 2006 to 2021, with sociodemographic and clinical data gathered from public health and social records.

During the follow-up period, 6.4% of the sample died, with an average age of death of 53.4 years. Leading causes of death included cancer, suicide, heart disease, cirrhosis of the liver, drug overdose, Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome, chronic obstructive pulmonary disease, meningitis, and sepsis. Multivariate analysis revealed that age, alcohol addiction, and being born in Spain were the factors most strongly correlated with the mortality of PEH.

Study findings underscore the significant health issues and socio-healthcare inequalities faced by this population, and highlight particular disparities between native-born and migrant PEH.

Public policy relevance statement

This study highlights the urgent need for targeted interventions and policy reforms to address health disparities affecting PEH in Spain, especially those who are native-born. PEH face higher rates of mental disorders, infections (Hepatitis C Virus, Human Immunodeficiency Virus, tuberculosis), and chronic conditions (hypertension, diabetes mellitus, chronic obstructive pulmonary disease, cardiovascular disease, cancer), leading to a life expectancy up to 30 years lower than the general population.