Homeless people living on the street in Boston had a death rate nearly three times higher than those living in shelters and almost 10 times higher than the general Massachusetts population, a new study has found.
The study, published Monday online in the journal JAMA Internal Medicine, looked at 445 unsheltered homeless adults who were “sleeping rough” in 2000 and followed what happened to them over 10 years. One hundred and thirty-four of them died.
“Mortality rates for unsheltered homeless adults in this study were higher than those for the Massachusetts adult population and a sheltered adult homeless cohort with equivalent services. This study suggests that this distinct subpopulation of homeless people merits special attention to meet their unique clinical and psychosocial needs,” said the study, whose lead author was Jill S. Roncarati, a researcher at the Harvard T.H. Chan School of Public Health.
The findings demonstrate “how much more vulnerable this group is,” Roncarati said in an e-mail.
Researchers said they found that the most common causes of death were noncommunicable diseases (such as cancer and heart disease), alcohol use disorder, and chronic liver disease.
Previous studies have shown that there are higher mortality rates among the homeless, but this one looked at rates for the subgroup of those living on the streets, a “population that wanders across our urban landscapes,” which has made data difficult to gather, the study said.
An estimate from one night in January 2017 found that across the United States nearly 193,000 were sleeping outside, the study said.
The study said “a patient-centered, outreach service model with integrated medical and behavioral health care delivered directly to the unsheltered population” was needed.
The researchers’ recommendations also included “greater availability and access to substance use disorder treatment, including smoking cessation; and a continuum of housing models with flexible social services to meet individual needs for successful tenancies.”
In a related commentary in the journal, Dr. Mitchell Katz, president and chief executive of New York City Health and Hospitals, said, “There will always be those who, because of personal choice, decompensated mental health, or substance use disorders, engage in behaviors that will put them at risk for early death.”
“Roncarati et al remind us about the heterogeneity of the homeless population and document the deadly repercussions of rough sleeping. Their work shows that, while access to housing remains the linchpin to address homelessness, the need for immediate, diverse, and innovative solutions is urgent,” he wrote.