Death on the Street: 12-year prospective study of mortality of a rough sleeper population in Boston MA 2000-2011

A dearth of literature exists to document the number and causes of deaths among chronically homeless rough sleepers, homeless individuals who sleep outside despite access to shelter. We assessed the mortality in a cohort of rough sleepers followed by the Boston Health Care for the Homeless Program<font >

A 12-year prospective study was used to determine the number and causes of deaths among a cohort of 445 chronically homeless rough sleepers identified in January 2000. The cohort includes 119 <font >

There are 119 high-risk and 326 non high-risk individuals. Of the 445, 321 are male and 124 are female. Race includes: 301 White, 92 Black, 21 Native American, 19 Hispanic, 3 Asian, and 9 unreported. After 12 years, at least 137 patients are deceased. Deaths occurred equally in every season and were not concentrated in the colder months. The most common causes of death included cancer, cardiovascular disease, and cirrhosis. More work is currently being completed to determine the all-cause and cause-specific mortality rates of this cohort and to determine if the high-risk criteria predicts mortality.

Mortality is very high among those living on the streets of Boston. The streets are equally dangerous during the warm and cold months of the year. This cohort of street persons had very high utilization of emergency rooms, hospitals, and detoxification units. Improvement in the identification of those at risk and improved coordination of care may help reduce mortality in this vulnerable population.