Table 3. Causes of Sudden Death by Autopsy in Unhoused Individuals Compared With Housed Individuals in San Francisco County, 2011-2018a.
| Cause of death | Individuals, No. (%) | P value | |
|---|---|---|---|
| Unhoused (n = 151) | Housed (n = 717) | ||
| Arrhythmic | 48 (31.8) | 420 (58.6) | <.001 |
| Acute coronary artery disease | 6 (4.0) | 66 (9.2) | .03 |
| Chronic coronary artery disease | 14 (9.3) | 172 (24.0) | <.001 |
| Cardiomyopathy | 14 (9.3) | 71 (9.9) | .81 |
| Cause | |||
| Drug or alcohol induced | 12 (7.9) | 26 (3.6) | .02 |
| Nonischemic/dilated/idiopathic | 2 (1.3) | 38 (5.3) | .02 |
| Amyloidosis | 0 | 2 (0.3) | .52 |
| Otherb | 0 | 5 (0.7) | .30 |
| Hypertrophy | 10 (6.6) | 65 (9.1) | .33 |
| Cause | |||
| Hypertensive heart disease | 7 (4.6) | 50 (7.0) | .29 |
| Hypertrophic cardiomyopathy | 1 (0.7) | 8 (1.1) | .63 |
| Unspecified | 2 (1.3) | 7 (1.0) | .70 |
| Primary electrical disease | 2 (1.3) | 14 (2.0) | .60 |
| Valvular disease | 0 | 11 (1.5) | .13 |
| Otherc | 2 (1.3) | 21 (2.9) | .27 |
| Cardiac, nonarrhythmic | 7 (4.6) | 27 (3.8) | .62 |
| Noncardiac | 96 (63.6) | 270 (37.7) | <.001 |
| Acute kidney failure | 1 (0.7) | 7 (1.0) | .71 |
| Aortic dissection | 4 (2.7) | 20 (2.8) | .92 |
| Aspiration/asphyxia | 2 (1.3) | 3 (0.4) | .18 |
| Occult overdose | 48 (31.8) | 90 (12.6) | <.001 |
| Culprit drugd | |||
| Cocaine | 11 (7.3) | 22 (3.1) | .01 |
| Alcohol | 20 (13.2) | 15 (2.1) | <.001 |
| Methamphetamine | 13 (8.6) | 20 (2.8) | .001 |
| Opioid | 10 (6.6) | 17 (2.4) | .006 |
| Opiate | 2 (1.3) | 28 (3.9) | .12 |
| Methadone | 7 (4.6) | 16 (2.2) | .10 |
| Benzodiazepine | 3 (2.0) | 14 (2.0) | .98 |
| Othere | 6 (4.0) | 14 (2.0) | .13 |
| Antidepressant/antipsychoticf | 3 (2.0) | 19 (2.6) | .64 |
| Gastrointestinal causes | 8 (5.3) | 15 (2.1) | .03 |
| Hypoglycemia/hyperglycemia/DKA | 5 (3.3) | 10 (1.4) | .10 |
| Infection | 11 (7.3) | 20 (2.8) | .01 |
| Type of infection | |||
| Peritonitis | 4 (2.6) | 3 (0.4) | .01 |
| Pneumonia | 5 (3.3) | 11 (1.5) | .14 |
| Cystitis/pyelonephritis | 2 (1.3) | 1 (0.1) | .02 |
| Meningitis | 0 | 1 (0.1) | .65 |
| Skin/soft tissue | 0 | 2 (0.3) | .52 |
| Otherg | 0 | 2 (0.3) | .52 |
| Neurologic | 5 (3.3) | 46 (6.4) | .14 |
| Pulmonary embolism | 5 (3.3) | 33 (4.6) | .48 |
| Other noncardiac | 7 (4.6) | 25 (3.5) | .50 |
Abbreviation: DKA, diabetic ketoacidosis.
Medical records were accessible for 860 of 867 individuals.
Other cardiomyopathy types in the housed group include arrhythmogenic right ventricular dysplasia (n = 1), HIV-related cardiomyopathy (n = 1), mitral valve prolapse (n = 1), noncompaction cardiomyopathy (n = 1), and stress cardiomyopathy (n = 1).
Other causes of arrhythmic deaths include myocardial infarction without coronary artery disease (1 among unhoused individuals, 4 among housed individuals), healed myocardial infarction (1 among unhoused individuals, 9 among housed individuals), acquired long QT syndrome (1 among housed individuals), myocarditis (3 among housed individuals), and device failure or concern (4 among housed individuals).
Sum of all reported percentages exceed 100% because of instances in which polysubstance use contributed to overdose.
Other causes of overdose included diphenhydramine, phenobarbital, topiramate, trazadone, gabapentin, tramadol, zolpidem, and carisoprodol.
Antidepressants included serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants, and atypical antidepressants.
Other causes of infection included 1 instance of meningitis and 1 instance of disseminated cryptococcus.