Mortality rates among homeless adults in Boston who avoid shelters, known as 'rough sleepers'

Bottom Line: A group of unsheltered homeless adults in Boston known as "rough sleepers" because they avoid shelters and instead sleep on park benches, in alleyways, train stations and abandoned cars had much higher mortality rates than homeless adults who slept in emergency shelters and the Massachusetts adult population in general. This 10-year observational study of 445 unsheltered homeless adults (of whom 134 died during the study period) was an attempt to understand more about this unique subpopulation of homeless adults. Common causes of death were noncommunicable diseases, such as cancer and heart disease, as well as substance use and chronic liver disease.

Authors: Jill S. Roncarati, Sc.D., M.P.H., P.A.-C, of the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and coauthors

Related Material: The invited commentary, "Death Among the Unsheltered Homeless: Hidden in Plain Sight," by Michael Incze, M.D., M.S.Ed., of the University of California, San Francisco, and Mitchell H. Katz, M.D., of New York City Health and Hospitals and deputy editor of JAMA Internal Medicine, is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.2924)

Editor's Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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