Medicolegal death of homeless persons in Tokyo Metropolis over 12 years (1999-2010)

Abstract

Background: Recently, the number of homeless persons in Japan has steadily decreased. However, it is not certain whether unexpected death of the homeless have actually decreased in proportion to decrease in total number of cases.

Methods: The documentation of medicolegal deaths among homeless persons handled in the Tokyo Medical Examiner's Office during 1999-2010 were reviewed, and we compared the number and manner/cause of death between cases occurring before 2004 and those occurring after 2004. In addition, we compared manner/cause of death between homeless and non-homeless persons.

Results: The number of medicolegal deaths of homeless persons remained almost the same during the study period in spite of a marked decrease in the total number of homeless persons after 2004. Age distribution shifted to older after 2004, and a higher proportion of the deceased had longer postmortem periods after 2004. Comparison between the manners/causes of death of the cases occurring before 2004 and those occurring after 2004 showed little difference. Disease constituted about 70% of all cases, and causes of death from disease were more various than those of non-homeless persons. Certain specific patterns included a higher proportion of death from circulatory disease in elderly homeless persons and a higher proportion of death from alcohol-related digestive disease and tuberculosis among younger homeless persons. Regarding accidental death, hypothermia was a leading cause of death irrespective of age group.

Conclusion: Aging and isolation among homeless persons might contribute to an unchanged number of medicolegal death of them. In addition to measures to address frequent causes of death in each age group, better intervention for isolated homeless persons might be a key factor to prevent unexpected deaths of homeless persons in the future.