We examined all unnatural and unexpected natural deaths of homeless people between 2,000 and 2,004 in Osaka, based on the reports of the Osaka Medical Examiners' Office and the data of Osaka Prefectural Police. Homeless people in this study were defined as those who slept rough or stayed in flophouse. A total of 1,052 deaths of homeless people (1,026 men and 26 women) was identified, 769 of those who slept rough, and 283 of those who stayed in flophouse. The autopsy rate amounted to 43.8%. The average age of death is 57.8 +/- 8.9 years. About 13.6% of homeless people died unexpectedly or unnaturally in five years. Of the total deaths, 69% died of disease, 12% of suicide, 3% of homicide, and 10% of accidents, including 4% from starvation and 7% from cold.