Ohsaka Takako, Sakai Yoshio, Kuroda Kenji, Matoba Ryoji
Department of Legal Medicine, Osaka University Graduate School.
Nihon Koshu Eisei Zasshi. 2003 Aug;50(8):686-96.
Problems of homelessness have been worsening recently in urban areas in Japan. The purpose of this study was to clarify the number and nature of deaths of homeless people in Osaka City.
All deaths of homeless people in 2000 in Osaka City were examined by reviewing the records of abnormal deaths kept at the Osaka Prefecture Medical Examiner's Office and the records of autopsies at the Department of Legal Medicine, Osaka University. Homeless people in this study were defined as those who were living on the street or staying in flophouses.
A total of 294 deaths of homeless were identified, 213 of those who lived on the street and 81 of those who stayed in flophouses. The average age at death was 56.2 years old. Of those who had money on them when they were found, half had only 1,000 yen or less. Of the total death, 172 (59%) died of disease, 47 (16%) of suicide, 6 (2%) of homicide, and 43 (15%) of accidents including 8 from starvation and 12 from cold. Causes of death from disease were identified with the following order of frequencies: cardiac disease, hepatitis and cirrhosis, pneumonia, lung tuberculosis, cerebrovascular disease, malnutrition, malignant neoplasm and peptic ulcer. All those who died of malnutrition, starvation and cold were more than 40 years old and had less money on them at their death than the others. Malnutrition and starvation occurred throughout the year, while deaths from cold were concentrated in winter, especially in February. Standardized mortality ratios (SMRs) for homeless men living on the street in Osaka City were calculated with Japanese males as the standard population. The SMR for all causes of death was 3.6, for cardiac disease 3.3, for pneumonia 4.5, for tuberculosis 44.8, for hepatitis and cirrhosis 4.1, for peptic ulcer 8.6, for suicide 6.0, and for homicide 78.9. All these figures were statistically significantly higher than for the standard population.
Our results show that most homeless people die untimely from preventable causes such as pneumonia, malnutrition and starvation. This suggests that these people are not provided with the necessary health care.
近年来，日本城市地区的无家可归问题日益严重。本研究旨在查明大阪市无家可归者的死亡人数及死亡性质。
通过查阅大阪府法医办公室保存的非正常死亡记录以及大阪大学法医学系的尸检记录，对2000年大阪市所有无家可归者的死亡情况进行了调查。本研究中的无家可归者定义为那些露宿街头或居住在廉价旅馆的人。
共确认了294例无家可归者的死亡，其中213例露宿街头，81例居住在廉价旅馆。平均死亡年龄为56.2岁。在被发现时身上有钱的人中，一半人的钱只有1000日元或更少。在所有死亡者中，172例（59%）死于疾病，47例（16%）自杀，6例（2%）他杀，43例（15%）死于事故，其中8例死于饥饿，12例死于寒冷。疾病导致的死亡原因按频率排序如下：心脏病、肝炎和肝硬化、肺炎、肺结核、脑血管疾病、营养不良、恶性肿瘤和消化性溃疡。所有死于营养不良、饥饿和寒冷的人年龄均超过40岁，且死亡时身上的钱比其他人少。营养不良和饥饿全年都有发生，而寒冷导致的死亡集中在冬季，尤其是2月。以日本男性为标准人群，计算了大阪市露宿街头的无家可归男性的标准化死亡率（SMR）。所有原因导致的SMR为3.6，心脏病为3.3，肺炎为4.5，肺结核为44.8，肝炎和肝硬化为4.1，消化性溃疡为8.6，自杀为6.0，他杀为78.9。所有这些数字在统计学上均显著高于标准人群。
我们的结果表明，大多数无家可归者死于肺炎、营养不良和饥饿等可预防的原因，这表明这些人没有得到必要的医疗保健。
