A study led by investigators from Massachusetts General Hospital and the Boston Health Care for the Homeless Program compared rates and causes of death among those served by BHCHP with data from a similar 1997 study and found that while drug overdose had replaced HIV as the leading cause of death, overall mortality rates had not changed. Dr. Hwang conducted the 1997 study.
“Our findings are an unfortunate reminder of the high mortality rate of homeless people and a clarion call for the need to address the epidemic of drug overdose deaths in this vulnerable population,” said the lead researcher, Dr. Travis Baggett of the MGH Department of Medicine and BHCHP.
“Overall, young homeless people died at a nine times higher rate and middle-aged homeless people at a four-and-a-half times higher rate than comparably aged adults in Massachusetts.”
The study, which will appear in the Feb. 11 issue of JAMA Internal Medicine (formerly Archives of Internal Medicine) and was posted online today, updates the previous study that covered the years 1988 to 1993. That report found that HIV was the leading cause of death among BHCHP patients aged 25 to 44, while homicide was the principal cause among those 18 to 24. Heart disease and cancer were the leading causes of death in those 45 to 64. To update that data, the investigators analyzed available information for more than 28,000 adult patients who had received care from BHCHP from 2003 through 2008.
Drug overdoses accounted for almost 17 percent of all deaths among the homeless patients studied, and 81 percent of those overdoses involved opioid drugs. Cancer and heart disease – again the primary causes of death among older homeless individuals – each accounted for nearly 16 percent of deaths among the overall homeless population. Health issues associated with substance abuse – such as alcoholism-associated heart disease, pneumonia and withdrawal – accounted for 8 percent of deaths.
The significant drop in deaths from HIV infection was offset by the increase in deaths from overdoses and other substance-abuse-related issues, resulting in no change in the overall mortality rates from the earlier study. Overall mortality was higher in white individuals than in black or Hispanic homeless people, which – the authors write – may be due to a disproportionate burden of substance abuse and mental illness among white homeless individuals as compared to homeless minorities.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.