Homeless mortality in Poland: evidence from the social assistance and public health burials data

Homelessness is increasingly recognized as particularly detrimental to health. However, data on the health and deaths of people experiencing homelessness are scarce and prone to selectivity and bias. No such estimation has been conducted in Poland so far. This paper aims to fill this gap by exploring administrative data and estimating the number of homeless deaths and mortality rates in this group in Poland. We used the burial benefit data from the social assistance beneficiaries dataset as a proxy for death. Where a personal identification number was available, cases were checked against the death register. In cases where beneficiaries disappeared from the dataset, the probability of death was estimated. These numbers were used to calculate crude mortality rates (CMRs) and standardized mortality ratios (SMRs). Additionally, total numbers of homeless public health burials in municipalities were explored for spatial patterns. In a population of about 30,000, we identified about 1200 deaths per year. In 2022, the mean age at death was 57.2 years (standard deviation [SD] = 11.9), with a CMR of 3.76 and SMR of 3.69 (95% confidence interval [CI] 3.48–3.91). Apart from age, the group receiving a burial benefit was not statistically different from the wider homeless population receiving benefits. However, homeless deaths were concentrated in urban municipalities, which may be explained by greater service availability, but also by weaker family ties. The findings provide empirical evidence for the need to monitor excess mortality in marginalized groups. The paper also presents the challenges of working with the available data and the caveats of the current homelessness data collection system.