Drug overdose was the leading cause of death among homeless adults in Boston from 2003 to 2008 and accounted for one-third of deaths among those ages 25 to 44. A study by investigators from the MGH and the Boston Health Care for the Homeless Program (BHCHP) 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.
“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,” says Travis Baggett, MD, MPH, of the MGH Department of Medicine and BHCHP, who led the study.
“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 and is receiving early online release, updates the previous study covering 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. 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. The significant drop in deaths from HIV infection was offset by an increase in deaths from overdoses and other substance-abuse-related issues, resulting in no change in the overall mortality rates from the earlier study.
“Our results highlight the dire need to expand addiction and mental health services and to better integrate them into primary care systems serving homeless people,” says Baggett. “They also suggest that, while health care services like BHCHP can help improve the health of homeless people, they probably are not enough. Making a major impact on mortality for these patients will also require addressing the social factors that contribute to homelessness in the first place.”
In response to the study, BHCHP and the Boston Public Health Commission are leading a citywide effort to address the high number of overdose deaths from a medical and policy perspective.
Read more articles from the 01/18/13 Hotline issue.