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17-01-2013 | Public health | Article

Shift in main cause of homeless deaths


Free abstract

medwireNews: Drug overdose is the leading cause of mortality in the Boston homeless population and has replaced HIV as an emerging epidemic, report researchers.

Although mortality from HIV in homeless people in Boston, Massachusetts, USA, has declined over the past 15 years, there have been substantial increases in addiction- and mental health-related mortality rates, resulting in no overall decrease in mortality in this area, research shows.

Travis Baggett (Massachusetts General Hospital, Boston, USA), who led the study, and team call for behavioral health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to help reduce mortality in this population as well as homelessness itself.

Baggett and team found that a total of 1302 deaths occurred between January 2003 and December 2008 in a cohort of 28,033 homeless adults aged 18 years or over who were seen at a homeless healthcare program in Boston.

Drug overdose was the leading cause of death and accounted for 16.8% of all deaths in the cohort. Opioid use was responsible for 81% of overdose deaths; of these, heroin was implicated in 13%, opioid analgesics in 31%, and other and unspecified narcotics in 60%. In addition, 37% of overdose deaths were attributed to cocaine use, while 43% of overdose deaths were attributed to multiple substances.

As reported in JAMA Internal Medicine, alcohol was a co-factor in 32% of drug overdose deaths.

In addition to drug overdose, cancer and heart disease were also major causes of death, each accounting for around 16% of all deaths.

The most common cause of death in homeless people aged 25-44 years was drug overdose, which led to 35% of all deaths in this age group. The rate of drug overdose deaths was 16-24-fold higher in Boston homeless people during 2003-2008 than in the Massachusetts general population.

There was a threefold increase in drug overdose deaths and a twofold increase in suicide deaths among homeless people during 2003-2008 compared with during 1988-1993, which contributed to an 83% higher rate of deaths due to external causes.

In comparison with 1988-1993, reductions in deaths from HIV during 2003-2008 were offset by three- and twofold increases in deaths owing to drug overdose and psychoactive substance use disorders, resulting in no significant difference in overall mortality.

"The mortality disparity between homeless individuals and the general population, particularly among those who are youngest, underscores the need to address the social determinants of health through policy initiatives to eradicate homelessness," conclude the authors.

By Piriya Mahendra, medwireNews Reporter

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