Journal of Urban Health

, Volume 76, Issue 1, pp 73–84 | Cite as

Disease patterns of the homeless in Tokyo

  • Takehito Takano
  • Keiko Nakamura
  • Sachiko Takeuchi
  • Masafumi Watanabe
Original Article


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 


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  1. 1.
    A New Urban Problem and Direction of Measures: About Life on the Street. Tokyo: Tokyo Metropolitan Government, Office of Planning and Coordination; 1995.Google Scholar
  2. 2.
    Statistics Bureau, Japanese Management and Coordination Agency.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. 3.
    Iwata M. The homeless in Shinjuku 1995–96.J Soc Sci Humanities (Jinbun Gakuho). 1997; 281:73–99 (in Japanese).Google Scholar
  4. 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.Google Scholar
  5. 5.
    Statistics and Information Department, Minister's Secretariat, Japanese Ministry of Health and Welfare.Patient Survey 1993. Tokyo: Health and Welfare Statistics Association; 1995.Google Scholar
  6. 6.
    Rossi PH, Wright JD, Fisher GA, Willis G. The urban homeless: estimating composition and size.Science. 1987;235:1336–1341.PubMedGoogle Scholar
  7. 7.
    Winkleby MA, Rockhill B, Jatulis D, Fortmann SP. The medical origins of homelessness.Am J Public Health. 1992;82:1394–1398.PubMedGoogle Scholar
  8. 8.
    Robertson MJ, Cousineau MR. Health status and access to health services among the urban homeless.Am J Public Health. 1986;76:561–563.PubMedGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 12.
    1995 Annual Report of Tokyo Metropolitan Medical Examiner's Office. Tokyo: Tokyo Metropolitan Medical Examiner's Office; 1996.Google Scholar
  13. 13.
    Statistics Bureau, Japanese Management and Coordination Agency.1990 Population Census of Japan Volume 4-1, Results of the Third Basic Complete Tabulation. Tokyo: Japan Statistical Association; 1993.Google Scholar
  14. 14.
    Sonobe M. City and homelessness.City Plann Rev. 1997;46:57–60.Google Scholar
  15. 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.Google Scholar
  16. 16.
    Susser E, Struening EL, Conover S. Psychiatric problems in homeless men.Arch Gen Psychiatry. 1989;46:845–850.PubMedGoogle Scholar
  17. 17.
    Lamb HR. Deinstitutionalization and the homeless mentally ill.Hosp Community Psychiatry. 1984;35:899–907.PubMedGoogle Scholar
  18. 18.
    Welte JW, Barnes GM. Drinking among homeless and marginally housed adults in New York State.J Stud Alcohol. 1992;53:303–315.PubMedGoogle Scholar
  19. 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. 1994;29:181–186.Google Scholar
  20. 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.Google Scholar
  21. 21.
    AIDS, Tuberculosis, Infectious Disease Control Division, Health Service Bureau, Japanese Ministry of Health and Welfare.Statistics of Tuberculosis 1995. Tokyo: Tuberculosis Prevention Association; 1995.Google Scholar
  22. 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.Google Scholar
  23. 23.
    Yamanaka K, Kondo T, Miyao M. Tuberculosis among the homeless people of Nagoya, Japan.Respir Med. 1994;88:763–769.Google Scholar
  24. 24.
    Toyota E, Yoshizawa A, Takahara M, et al. Antituberculosis drug-resistance among homeless people.Kekkaku. 1996;71:13–17.PubMedGoogle Scholar
  25. 25.
    Schieffelbein CW Jr, Snider DE Jr. Tuberculosis control among homeless populations.Arch Intern Med. 1988;148:1843–1846.CrossRefPubMedGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 27.
    Slutkin G. Management of tuberculosis in urban homeless indigents.Public Health Rep. 1986;101:481–485.PubMedGoogle Scholar
  28. 28.
    McGowan JE Jr, Blumberg HM. Inner-city tuberculosis in the USA.J Hosp Infect. 1995; 30:282–295.PubMedGoogle Scholar
  29. 29.
    Takano T, Nakamura K, Motohashi Y, Takeuchi F, Tanaka A. Health issues in developed and high-density urban environments. In: Takano T, ed.Urban Health. Tokyo: Kyoiku Syoseki; 1993:155–231.Google Scholar

Copyright information

© The New York Academy of Medicine 1999

Authors and Affiliations

  • Takehito Takano
    • 1
  • Keiko Nakamura
    • 1
  • Sachiko Takeuchi
    • 1
  • Masafumi Watanabe
    • 1
  1. 1.Department of Public Health and Environmental Science, School of MedicineTokyo Medical and Dental UniversityTokyoJapan

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