Chronic Illnesses/Diseases and Mortality

Chronic Illnesses/Diseases and Mortality

Studies have documented the high burden of illness among homeless people due to chronic medical conditions, tuberculosis and HIV infection, and traumatic injuries. These illnesses, in conjunction with severe poverty and inadequate access to health care, lead to high mortality rates among homeless people. 

Chronic medical problems that are prevalent among homeless adults include seizures, chronic obstructive pulmonary disease, arthritis and other musculoskeletal disorders. Conditions such as hypertension, diabetes and anemia are often inadequately controlled and may go undetected for long periods. Respiratory tract infections are common and oral and dental health is often poor. 

Homeless people are at increased risk of contracting tuberculosis (TB), a diagnosis that should be considered in any homeless individual with a fever and a persistent productive cough. Conditions favouring TB outbreaks in shelters include crowding, large transient populations and inadequate ventilation. More than half of all TB cases among homeless people represent clusters of primary tuberculosis rather than reactivation of old disease. 

HIV/AIDS is a common cause of death among people experiencing homelessness. Common risk factors for HIV infection in homeless youth in Canada include prostitution, multiple sexual partners, inconsistent use of condoms, and injection drug use. In homeless adults, injection drug use and crack cocaine, rather than sexual behaviours, were associated with an increased likelihood of HIV infection. 

Homeless people have a greatly increased risk of death. Unintentional injuries are a leading cause of morbidity and mortality, especially among homeless men. Injuries are often the result of falls or being struck by a motor vehicle. Deaths due to an unintentional overdose of drugs or alcohol, or both, are also common. Exposure to the elements is a major hazard. In cold weather, the risk of frostbite and hypothermia is substantial, and deaths due to freezing are not uncommon. In hot weather, severe sunburn and heatstroke can occur.