Morbidity and mortality among people experiencing severe and multiple disadvantage: a retrospective cohort study using cross-sectoral data linkage

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People affected by homelessness, imprisonment, drug addiction, or severe mental illness tend to have very poor health, and are at high risk of dying early. Despite increasing evidence that these experiences are often closely linked, most previous research has looked at each in isolation. As a result, we know very little about how the combination of these factors – sometimes known as ‘severe and multiple disadvantage’ (SMD) – affects health. This is especially relevant in the context of recent increases across the UK in housing insecurity, drug-related harms and prison deaths. 

This study will investigate the health of people with SMD by bringing together existing databases from health, social care and prison services in a secure and confidential way. It will provide the first comprehensive picture of what conditions cause ill-health and death among people with SMD, addressing key research priorities identified by the affected population, policymakers, and healthcare professionals. Using these results, we can improve the services provided for this vulnerable population and develop tailored interventions to better meet their needs.

Linkage of routinely collected data is a particularly valuable technique for studying the experiences of people with adverse social circumstances, who are often not recruited to or retained in traditional cohort studies. Scotland’s world-leading track record in data linkage makes it an ideal place to undertake this research.


Emily Tweed
Vittal Katikireddi
Alastair Leyland
David Morrison (Public Health, Institute of Health and Wellbeing)

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