S.F. homeless have 16 times higher risk of sudden death, study finds
Homeless people in San Francisco are 16 times more likely to die a sudden death than those who are housed, according to a study published Monday in the Journal of the American Medical Association.
Researchers at UCSF analyzed more than 860 autopsies of sudden cardiac deaths from 2011 to 2018 to study how causes of sudden death differed among San Francisco’s homeless and housed residents. It’s a subset of a larger collaboration between Dr. Zian Tseng, a cardiologist and professor at UCSF, and Assistant Medical Examiner Dr. Ellen Moffatt.
The study’s findings put it generally in line with previous research that has shown homeless people have a significantly higher mortality rate overall, according to Tseng.
But the researchers found that stays true even when excluding deaths from sudden overdoses; homeless people were still seven times more likely to have died from sudden cardiac death, according to the study.
Of the 151 homeless people in the study, just under 32% died from drug or alcohol overdoses compared with 12.6% of housed individuals. Homeless people also more often died from infections, such as pneumonia, and gastrointestinal issues, according to the study.
“The study underscores how housing status is a big social determinant of one’s health, and that homeless individuals are a vulnerable population with specific health needs,” said Dr. Leila Haghighat, a cardiology fellow at UCSF and first author on the paper.
Its results provide guidance on how public health agencies might approach efforts to reduce high mortality rates among San Francisco’s homeless population.
In particular, the study’s authors note that arrhythmic causes of death, which could be prevented using a defibrillator, were responsible for just as many deaths as overdoses over the study’s eight years of data.
“Arrhythmic death is where your heart electrically stops working in a coordinated fashion; it goes into a chaotic rhythm. The only way to restore circulation is to immediately shock that heart back into normal rhythm,” Tseng explained. “Unfortunately, these events are completely unpredictable.”
Public safety agencies such as fire stations, as well as doctors’ offices, grocery stores and gyms often keep defibrillators — devices that electrically shock the heart — on hand for public use.
Making the devices available in places where homeless people tend to gather could make it easier to intervene and save lives, particularly when minutes and even seconds can make a difference in the event of a sudden arrhythmic death, Haghighat said.
Vaccine drives could also be effective at preventing infections, which were responsible for 7.3% of deaths among homeless people in the study, she suggested.
“It’s well beyond the stereotypical causes of death in the homeless population, such as overdose,” Tseng said. “To improve survival in this vulnerable population requires us to have an open mind into all of these underlying causes.”