Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #107868

James J. O'Connell, MD, H. Joslyn Allen, MSSW, and Jill Roncarati, PA-C. Boston Health Care for the Homeless Program, 729 Massachusetts Avenue, Boston, MA 02118, 617-414-7763, joconnell@bhchp.org

BACKGROUND: Rough sleepers live on the streets and avoid shelters and constitute a vulnerable subset of the homeless population who are at risk for premature death. METHODS: A five-year observational study of 119 high-risk and chronically homeless rough sleepers was undertaken from 2000 through 2004 to examine the causes and circumstances of deaths among rough sleepers in Boston. Criteria for inclusion in this cohort include age over 18, living on the streets for at least six consecutive months, and one or more of seven identified risk factors. Data sources (including BHCHP's electronic medical record, medical records at two academic teaching hospitals, and death certificates) were tapped to describe the number of deaths, demographics, place of death, cause of death, service utilization, burden of illness, and other relevant factors. RESULTS: 33 (28%) of the 119 individuals died during the five year study, despite an average age of 51. Despite high rates of mental illness and substance abuse in this cohort, the causes of death have been primarily medical conditions, especially cancer, AIDS, end-stage liver disease, and chronic pulmonary disease. CONCLUSION: Mortality is disproportionately high for persons living on the streets of Boston and indicates a marked health care disparity for this subgroup of the homeless population. The causes of death are primarily medical illnesses, many of which appear to be preventable. Improved understanding of the causes and circumstances surrounding these deaths can be used to improve service delivery models of health care to this vulnerable population.

Learning Objectives:

• Understand the causes of death and underlying medical problems of a cohort of urban rough sleepers.
• To discuss methods to improve practice and service delivery models to minimize preventable deaths.
• To discuss potential policy-making efforts in support of health care policies and programs that prevent premature deaths among the homeless.

Keywords: Homeless, Mortality

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation