The following is a summary of “Homelessness and Incidence and Causes of Sudden Death,” published in the October 2023 issue of Psychiatry by Haghighat, et al.

Over 580,000 Americans suffer homelessness, with the highest population. Unhoused people have a 50-year life expectancy, but how sudden death causes early death is unknown. For a study, researchers sought to compare autopsy rates and causes of sudden death among housed versus unhoused residents. The Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) research, a prospective cohort of countywide out-of-hospital cardiac arrest fatalities from 18 to 90 years old, was utilized for this cohort analysis. Cases satisfying WHO criteria for probable SCD underwent autopsy, toxicology, and medical record examination. From February 1, 2011, to March 1, 2014, all 525 incident SCDs in the original cohort were utilized to calculate rates. For cause analysis, 343 SCDs (almost every third day) from the expanded cohort (March 1, 2014, to December 16, 2018) were included. Data analysis spanned July 1, 2022, to July 1, 2023.  

Causes and incidence of suspected SCD by housing status were the primary results. Sudden death was classified as arrhythmic (possibly rescuable with implanted cardioverter-defibrillator), cardiac nonarrhythmic (tamponade), or noncardiac (overdose). Over eight years, 868 putative SCDs were identified: 151 unhoused (17.4%) and 717 housed (82.6%). Unhoused people were younger (56.7 [0.8] vs 61.0 [0.5] years) and more often male (132 [87.4%] vs 499 [69.6%]), with statistically significant racial differences. Although paramedic response times were similar (mean [SD] time to arrival, unhoused individuals: 5.6 [0.4] minutes; housed individuals: 5.6 [0.2] minutes; P = .99), the proportion of witnessed sudden deaths was lower among unhoused individuals (27 [18.0%] vs 184 [25.7%], respectively, P = .04). Higher rates of sudden and arrhythmic death were seen in unhoused persons (IRR, 16.2; 95% CI, 5.1-51.2; P < .001; IRR, 7.2; 95%, 1.3-40.1; P = .02). 

Even after controlling for age and sex, these relationships remained substantial. Sudden fatalities in unhoused persons were more likely to be caused by noncardiac reasons (96 [63.6%] vs 270 [37.7%], P < .001), such as occult overdose (48 [31.8%] vs 90 [12.6%], P < .001), gastrointestinal causes (8 [5.3%] vs 15 [2.1%], P = .03), and infection (11 [7.3%] vs 20 [2.8% Fewer unhoused persons died suddenly from arrhythmic reasons (48 of 151 [31.8%] versus 420 of 717 [58.6%], P < .001), including acute and chronic coronary disease. Homelessness was linked to higher rates of sudden death from noncardiac and arrhythmic causes that may be prevented with a defibrillator in this San Francisco County cohort research.

Source: jamanetwork.com/journals/jamainternalmedicine/article-abstract/2811089