Homelessness Key Social Determinant of Health Predicting Sudden Death

Homelessness remains a key social determinant of health, with researchers from the University of California, San Francisco, revealing that individuals who are homeless are 16 times more likely to experience sudden cardiac death than those who are not.

The study, which focused on the San Francisco area and was published in JAMA Internal Medicine, stresses the importance of making tools like defibrillators more easily accessible and of designing public health initiatives tailored toward ending drug use.

“Homeless individuals die young, at a mean age of 50 years,” Zian H. Tseng, MD, MAS, the study’s corresponding and senior author and a cardiologist and professor of medicine at UCSF, said in a statement. “Our study sheds light into the contribution of sudden death to the homeless population. We found both cardiac and non-cardiac causes, such as overdoses and unrecognized infections, are much higher among homeless individuals dying suddenly.”

“These findings offer several novel insights into the profound impact of homelessness on sudden death and its underlying causes,” Tseng added.

The eight-year study included 868 adult sudden deaths that met the World Health Organization’s criteria for presumed sudden cardiac death. Overall, 151 of the deaths examined in the study were of individuals who were unhoused.

Although paramedic response times were similar between the housed and unhoused individuals in the study, there were key differences the researchers examined.

For one thing, there were some age disparities.

Unhoused individuals who experienced sudden death tended to be younger, dying at age 57 compared to age 61 for housed individuals. They were also more likely to be male and had higher rates of alcohol and substance use and psychiatric conditions.

Notably, individuals experiencing homelessness were 16 times more likely to experience sudden cardiac death compared to housed individuals. Homeless individuals were more likely to die from noncardiac causes—such as drug overdoses, gastrointestinal disorders, and infection—whereas housed individuals were more likely to die from arrhythmic causes.

“While the high rate of substance use in the homeless population has long been recognized, our study demonstrates its association with early, sudden mortality and its true impact among the homeless,” first author Leila Haghighat, MD, MPhil, a cardiology fellow at UCSF, said in the press release. “By contrast, housed individuals more closely reflected the classic profile of sudden death that modern medical systems aim to resuscitate and prevent.”

The researchers stressed that these findings should shape public health interventions. For one thing, it could mean that public health approaches to tamping out drug and alcohol use should be reimagined.

“Public health interventions such as increasing the availability of automatic external defibrillators and redoubled efforts to treat substance use and targeted immunization efforts might be helpful to reduce sudden mortality,” Haghighat explained.

Homelessness is not a newly recognized social determinant of health. Several separate studies have outlined how homelessness can predict adverse health outcomes. COVID-19’s initial outbreak during the spring of 2020 stands out as a key example, with folks experiencing homelessness being more likely to contract the virus than their housed counterparts.

Housing insecurity during heatwaves, too, serves as a reminder of how the conditions unhoused individuals face can increase their risk of adverse health outcomes. In one 2022 study, researchers found that experiencing housing insecurity during a heatwave increases the odds of an emergency department visit by a factor of 1.29.

This latest UCSF study adds to that literature by looking at the factors associated with housing instability and homelessness that can affect sudden cardiac death, ideally helping to inform public health initiatives tailored to those trends and living conditions.