A survey of deaths of homeless people in Osaka City

Abstract

OBJECTIVE: Problems of homelessness have been worsening recently in urban areas in Japan. The purpose of this study was to clarify the number and nature of deaths of homeless people in Osaka City. METHODS: All deaths of homeless people in 2000 in Osaka City were examined by reviewing the records of abnormal deaths kept at the Osaka Prefecture Medical Examiner's Office and the records of autopsies at the Department of Legal Medicine, Osaka University. Homeless people in this study were defined as those who were living on the street or staying in flophouses. RESULTS: A total of 294 deaths of homeless were identified, 213 of those who lived on the street and 81 of those who stayed in flophouses. The average age at death was 56.2 years old. Of those who had money on them when they were found, half had only 1,000 yen or less. Of the total death, 172 (59%) died of disease, 47 (16%) of suicide, 6 (2%) of homicide, and 43 (15%) of accidents including 8 from starvation and 12 from cold. Causes of death from disease were identified with the following order of frequencies: cardiac disease, hepatitis and cirrhosis, pneumonia, lung tuberculosis, cerebrovascular disease, malnutrition, malignant neoplasm and peptic ulcer. All those who died of malnutrition, starvation and cold were more than 40 years old and had less money on them at their death than the others. Malnutrition and starvation occurred throughout the year, while deaths from cold were concentrated in winter, especially in February. Standardized mortality ratios (SMRs) for homeless men living on the street in Osaka City were calculated with Japanese males as the standard population. The SMR for all causes of death was 3.6, for cardiac disease 3.3, for pneumonia 4.5, for tuberculosis 44.8, for hepatitis and cirrhosis 4.1, for peptic ulcer 8.6, for suicide 6.0, and for homicide 78.9. All these figures were statistically significantly higher than for the standard population. CONCLUSION: Our results show that most homeless people die untimely from preventable causes such as pneumonia, malnutrition and starvation. This suggests that these people are not provided with the necessary health care.