Health and homelessness in Scotland: research

Study exploring the relationship between homelessness and health.


1. Culhane, D.P., Metraux, S. & Hadley, TR. (2002) Public service reductions associated with the placement of homeless people with severe mental illness in supportive housing. Housing Policy Debate 13(1) pp107-163.

2. See Fife Council's PowerPoint presentation available at:

3. The most recent publication was released in December, 2017. In 2007, a Ministerial Task Force on Health Inequalities, led by the Minister for Public Health, was established to identify and prioritise practical actions to reduce the most significant and widening health inequalities in Scotland. The Task Force recognised the need to monitor progress in tackling health inequalities in the longer term as well as managing short and medium term progress:

4. Understanding Emergency Care in NHSScotland. NHS National Services Scotland. September 2015. Available at:

5. An association between socioeconomic deprivation and primary care antibiotic prescribing in Scotland. / Covvey, Jordan R.; Johnston, Blair F.; Elliott, Victoria; Malcolm, William; Mullen, Alexander B. In: Journal of Antimicrobial Chemotherapy, Vol. 69, No. 3, 03.2014, p. 835-841. Available at:

6. Drug-Related Hospital Statistics. Scotland 2015/16. NHS National Services Scotland. September 2016. Available at:

7. Homelessness in Scotland: 2016-17:

8. Equality and Human Rights Commission, England's most disadvantaged groups: Homeless people. March 2016.

9. Department of Health. March 2010. Healthcare for Single Homeless People. Available at:

10. Fazel, S; Geddes, J.R; and Kushel, M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet. 2014 October 25; 384(9953): 1529–1540.

11. Aldridge,W.R.; et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet 2018; 391: 241–50

12. Hospitalisations and deaths for 6,323 homeless adults taken from Glasgow City Council's database covering a single year (2000) . The 12,626 cases for comparison were taken from the Community Health Index ( CHI) database for Glasgow. This sample was matched on age and sex and was drawn from the non-homeless population from across Glasgow. Analysis by deprivation levels was also considered.



15. Homelessness Statistics, Communities Analysis Division, 1F-Dockside, Victoria Quay, EH6 6QQ. Email:,

16. Contact details available at:

17. HL1 Guidance Notes – Updated December 2010

18. Homelessness in Scotland: Annual Publication 2016-17. National and Local Authority analyses. See Table 11. Proportion assessed as threatened with homelessness in 2002/3 = 5,002/ (5002+34,645)=13%

19. Housing (Scotland) Act 1987 (as amended). Available at:


21. Homelessness in Scotland: 2016-17. Scottish Government. Available at:

22. Homelessness in Scotland: 2016-17. Scottish Government. June 2017 .

23. Homelessness in Scotland: 2016-17. Scottish Government. June 2017 Available at:

24. Julian Tudor Hart, The Inverse Care Law. The Lancet. Volume 297, No. 7696, p405–412, 27 February 1971

25. Health inequalities in Scotland . Audit Scotland. December 2012. Available at:

26. If the NHS sends a patient to a private health care provider, this will still be included in the NHS data. This limitation refers to private patients.


28. An assumed age was used as some people in the cohort may have died before reaching the end of the study period.

29. 88 people were removed from the H2H controls – these applications contained multiple people - one of whom had died between the initial application being made but before the homeless assessment took place. The surviving people within the homeless application are retained as part of the study.

30. Prescriptions in the study only relate to mental health conditions, alcohol dependence, opioid dependence and tuberculosis. For more information, see section 2.3.6.



33. SIMD 2012 Background Data - Part 3 Income Domain. Available at:

34. SIMD 2012 Background Data - Part 4 Employment Domain. Available at:

35. Walsh, D. et al. History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow. Public Health. 2017 Oct;151:1-12. doi: 10.1016/j.puhe.2017.05.016. Epub 2017 Jul 8. Available at:

36. This refers to statutory homelessness, as defined in Chapter 2.

37. Some people – particularly those who require social work services following a hospital stay –may be clinically ready for discharge before their actual discharge date, but they are delayed in hospital whilst they wait for their care packages to be put in place. This may affect the different cohorts differently.


39. In this instance, the 'other condition' admission could still be related to multiple conditions.

40. Episode level data from patients on new and follow up appointments at outpatient clinics in all specialities. This includes appointments not kept.

41. Department of Health. March 2010. Healthcare for Single Homeless People. Available at:

42. Note that this is distinct from the acute inpatient admissions ( SMR01) with the mental health flag considered in Chapter 4.

43. 14.4% of the EHC have drug-related interactions compared with 10.6% for alcohol-related interactions. Whilst this is a 3.8% difference in percentage points, the number of people with drug-related interactions is 36% more than those with alcohol-related interactions.

44. Broderick R, McCoard S, Carnie J. Prisoners who have been in care as "looked after children". Scottish Prison Service; 2014. Available online at:

45. Scottish Public Health Observatory. Drug Misuse and Treatment in Scottish Prisons. Accessed 21 March 2018. Available at:

46. Joseph Rowntree Foundation. Tackling homelessness and exclusion: Understanding complex lives. September 2011. Available at:

47. Drug-Related Hospital Statistics from 2015/16 produce European Age and Sex Standardised Rates ( EASR) to allow comparisons across populations by controlling for differences in the age structure of local populations. 2015/16 EASR stays ( NHS Ayrshire and Arran 307.1, Scotland 181), EASR Patients ( NHS Ayrshire and Arran 222.8, Scotland 138.1) and EASR New Patients ( NHS Ayrshire and Arran 93.8, Scotland 71.8)

The full publication is NSS ISD. Drug-Related Hospital Statistics. Scotland. Financial Year 2016/17. Available at:

48. The 14 NHS Health Boards relate to the 32 local authorities in Scotland as follows:

NHS Ayrshire and Arran: East Ayrshire, North Ayrshire and South Ayrshire; NHS Borders: Scottish Borders; NHS Dumfries and Galloway: Dumfries and Galloway; NHS Fife: Fife; NHS Forth Valley: Clackmannanshire, Falkirk, Stirling; NHS Grampian: Aberdeen City, Aberdeenshire, Moray; NHS Greater Glasgow and Clyde: East Dunbartonshire, East Renfrewshire, Glasgow City, Inverclyde, Renfrewshire, West Dunbartonshire; NHS Highland: Argyll & Bute and Highland; NHS Lanarkshire: North Lanarkshire and South Lanarkshire; NHS Lothian: City of Edinburgh, East Lothian, Midlothian and West Lothian; NHS Orkney: Orkney Islands; NHS Shetland: Shetland Islands; NHS Tayside: Angus, Dundee City and Perth & Kinross; NHS Western Isles: Na h-Eileanan an Siar

49. 2015/16 EASR stays ( NHS Forth Valley 175.9, Scotland 181), for EASR Patients ( NHS Forth Valley 132.4, Scotland 138.1) and EASR New Patients ( NHS Forth Valley 74.3, Scotland 71.8)

50. 2015/16 EASR stays ( NHS Lanarkshire 157.6, Scotland 181), for EASR Patients ( NHS Lanarkshire 124.2, Scotland 138.1) and EASR New Patients ( NHS Lanarkshire 79.3, Scotland 71.8)

51. See for example Chart 3 in Operation of the Homeless Persons Legislation In Scotland: 2014-15 available at:

52. The SHS questionnaire is structured into three section: Household, Random Adult and Physical inspection of dwelling (

53. Crisis. Homeless Monitor 2015. Fitzpatrick S. et al. (

54. Scotland's People Annual report: Results from 2012. Scottish Household Survey

55. These records correspond to the number that can be attributed to the study's analysis population. This is defined in Section 2.5.4 – Analysis Cohorts.

56. These records correspond to the number that can be attributed to the study's analysis population. This is defined in Section 2.5.4 – Analysis Cohorts.

57. ICD10 is the International Statistical Classification of Diseases and Related Health Problems 10th Revision. More information on this is available at:

58. See



61. . This also includes tuberculosis (A15-A19).



64. Codes X60 to X84 as detailed at:–X84)_Intentional_self-harm

65. Codes X85 to Y09 as detailed at:–Y09)_Assault . In the deaths dataset, there were no deaths recorded as X85 to X90.



68. The H2H Data specification can be found at:

69. The Indexing Service at the National Records of Scotland acts as the Trusted Third Party for data linkage projects across Scotland

70. An assumed age was used as some people in the cohort may have died before reaching the end of the study period.

71. See for a further explanation of convolution.


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