Chronic Illnesses/Diseases and Mortality

Studies have documented the high burden of illness among people experiencing homelessness 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 those experiencing homelessness. 

Chronic medical problems that are prevalent among adults experiencing homelessness 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. 

People experiencing homelessness are also at increased risk of contracting tuberculosis (TB), a diagnosis that should be considered in any individual experiencing homelessness 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 people experiencing homelessness 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 youth experiencing homelessness include prostitution, multiple sexual partners, inconsistent use of condoms, and injection drug use. For adults experiencing homelessness, injection drug use and crack cocaine, rather than sexual behaviours, were associated with an increased likelihood of HIV infection. 

People experiencing homelessness have a greatly increased risk of death. Unintentional injuries, including falls or being struck by a vehicle, are a leading cause of morbidity and mortality among men experiencing homelessness. 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.