Skip to main content
NCBI home page
Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 1999 Mar;76(1):73–84. doi: 10.1007/BF02344463

Disease patterns of the homeless in Tokyo

Takehito Takano 1,✉, Keiko Nakamura 1, Sachiko Takeuchi 1, Masafumi Watanabe 1
PMCID: PMC3456708  PMID: 10091192

Abstract

In recent years, homelessness has been recognized as a growing urban social problem in various countries throughout the world. The health problems of the homeless are considerable. The purpose of this study was to elicit, with sociodemographic profiles, the disease patterns among Tokyo's homeless. The subjects were 1,938 men who stayed at a welfare institution from 1992 to 1996. Diagnosed diseases/injuries and sociodemographic profiles were analyzed. The disease patterns of the homeless were compared to those of the male general population. Of the subjects, 8.3% were admitted to the hospital; 64.0% received outpatient care. Their observed morbidity rates by disease category were greater than those of the male general population in both Japan and Tokyo. Comorbidity of alcoholic psychosis/alcohol-dependent syndrome to both liver disease and pulmonary tuberculosis were greater than the average (P<.01). Construction work brought a higher risk of pulmonary tuberculosis (odds ratio=2.0) and dorsopathies (odds ratio=1.4) than did other jobs (P<.05). Disease patterns among the homeless in Tokyo were characterized by alcoholic psychosis/alcohol-dependence syndrome; liver disease; pulmonary tuberculosis; diabetes mellitus; fractures, dislocations, sprains, strains; hypertension; and cerebrovascular disease. Although the sociodemographic backgrounds of Tokyo's homeless have become more diverse, the principal occupation of the homeless was unskilled daily construction work, which underlay the characteristics of their disease patterns.

Key Words: Disease Pattern, Homeless, Residential Instability

Full Text

The Full Text of this article is available as a PDF (642.2 KB).

References

  • 1.A New Urban Problem and Direction of Measures: About Life on the Street. Tokyo: Tokyo Metropolitan Government, Office of Planning and Coordination; 1995.
  • 2.1995 Population Census of Japan Volume 2-1, Sex, Age and Marital Status of Population, Structure and Housing Conditions of Households. Tokyo: Japan Statistical Association; 1996. [Google Scholar]
  • 3.Iwata M. The homeless in Shinjuku 1995–96. J Soc Sci Humanities (Jinbun Gakuho) 1997;281:73–99. [Google Scholar]
  • 4.A Report on the Qualitative Exploration for the Entrants of Winter Season's Temporary Accommodation. Tokyo: Society of Welfare Office Director of Tokyo's 23 Wards; 1995.
  • 5.Patient Survey 1993. Tokyo: Health and Welfare Statistics Association; 1995. [Google Scholar]
  • 6.Rossi PH, Wright JD, Fisher GA, Willis G. The urban homeless: estimating composition and size. Science. 1987;235:1336–1341. doi: 10.1126/science.2950592. [DOI] [PubMed] [Google Scholar]
  • 7.Winkleby MA, Rockhill B, Jatulis D, Fortmann SP. The medical origins of homelessness. Am J Public Health. 1992;82:1394–1398. doi: 10.2105/ajph.82.10.1394. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Robertson MJ, Cousineau MR. Health status and access to health services among the urban homeless. Am J Public Health. 1986;76:561–563. doi: 10.2105/ajph.76.5.561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Fischer PJ, Shapiro S, Breakey WR, Anthony JC, Kramer M. Mental health and social characteristics of the homeless: a survey of mission users. Am J Public Health. 1986;76:519–524. doi: 10.2105/ajph.76.5.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Bowering J, Clancy KL, Poppendieck J. Characteristics of a random sample of emergency food program users in New York: II. Soup kitchens. Am J Public Health. 1991;81:914–917. doi: 10.2105/ajph.81.7.914. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Paul EA, Lebowitz SM, Moore RE, Hoven CW, Bennett BA, Chen A. Nemesis revisited: tuberculosis infection in a New York City men's shelter. Am J Public Health. 1993;83:1743–1745. doi: 10.2105/ajph.83.12.1743. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.1995 Annual Report of Tokyo Metropolitan Medical Examiner's Office. Tokyo: Tokyo Metropolitan Medical Examiner's Office; 1996.
  • 13.1990 Population Census of Japan Volume 4-1, Results of the Third Basic Complete Tabulation. Tokyo: Japan Statistical Association; 1993. [Google Scholar]
  • 14.Sonobe M. City and homelessness. City Plann Rev. 1997;46:57–60. [Google Scholar]
  • 15.1995 Annual Report of the Human and Health Affair Union of City-wards of Tokyo Metropolis. Tokyo: Human and Health Affair Union of City-wards of Tokyo Metropolis; 1996.
  • 16.Susser E, Struening EL, Conover S. Psychiatric problems in homeless men. Arch Gen Psychiatry. 1989;46:845–850. doi: 10.1001/archpsyc.1989.01810090087012. [DOI] [PubMed] [Google Scholar]
  • 17.Lamb HR. Deinstitutionalization and the homeless mentally ill. Hosp Community Psychiatry. 1984;35:899–907. doi: 10.1176/ps.35.9.899. [DOI] [PubMed] [Google Scholar]
  • 18.Welte JW, Barnes GM. Drinking among homeless and marginally housed adults in New York State. J Stud Alcohol. 1992;53:303–315. doi: 10.15288/jsa.1992.53.303. [DOI] [PubMed] [Google Scholar]
  • 19.Yokoyama A, Matsushita S, Ishii H, Takagi T, Maruyama K, Tsuchiya M. The impact of diabetes mellitus on the prognosis of alcoholics. Alcohol Alcohol. 1999;29:181–186. [PubMed] [Google Scholar]
  • 20.Summary Report of a Joint United States-Japan Alcohol Epidemiological Project: Alcohol Consumption Patterns and Related Problems in the United States and Japan. Bethesda, Md: National Institute on Alcohol Abuse and Alcoholism (USA), and Kurihama, Kanagawa, Japan: National Institute on Alcoholism (Japan); 1991.
  • 21.Statistics of Tuberculosis 1995. Tokyo: Tuberculosis Prevention Association; 1995. [Google Scholar]
  • 22.Toyota E, Ootani N, Matsuda Y, Tajima H. An approach to the control of the so-called vagrant patients with tuberculosis. Kekkaku. 1990;65:19–22. [PubMed] [Google Scholar]
  • 23.Yamanaka K, Kondo T, Miyao M. Tuberculosis among the homeless people of Nagoya, Japan. Respir Med. 1999;88:763–769. doi: 10.1016/s0954-6111(05)80199-4. [DOI] [PubMed] [Google Scholar]
  • 24.Toyota E, Yoshizawa A, Takahara M, et al. Antituberculosis drug-resistance among homeless people. Kekkaku. 1996;71:13–17. [PubMed] [Google Scholar]
  • 25.Schieffelbein CW, Jr, Snider DE., Jr Tuberculosis control among homeless populations. Arch Intern Med. 1988;148:1843–1846. doi: 10.1001/archinte.148.8.1843. [DOI] [PubMed] [Google Scholar]
  • 26.Nardell E, McInnis B, Thomas B, Weidhaas S. Exogenous reinfection with tuberculosis in a shelter for the homeless. N Engl J Med. 1986;315:1570–1575. doi: 10.1056/NEJM198612183152502. [DOI] [PubMed] [Google Scholar]
  • 27.Slutkin G. Management of tuberculosis in urban homeless indigents. Public Health Rep. 1986;101:481–485. [PMC free article] [PubMed] [Google Scholar]
  • 28.McGowan JE, Jr, Blumberg HM. Inner-city tuberculosis in the USA. J Hosp Infect. 1995;30:282–295. doi: 10.1016/0195-6701(95)90031-4. [DOI] [PubMed] [Google Scholar]
  • 29.Takano T, Nakamura K, Motohashi Y, Takeuchi F, Tanaka A. Health issues in developed and high-density urban environments. In: Takano T, editor. Urban Health. Tokyo: Kyoiku Syoseki; 1993. pp. 155–231. [Google Scholar]

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES