Following two years of substantial spikes, the number of homeless people dying in Los Angeles County started to level off between 2021 and 2022 – but the difference in mortality rates between homeless individuals and the county’s general population still widened, according to a new report from the county’s Department of Public Health.
The county’s fifth annual report on the mortality rates of homeless people, released Thursday, May 9, was welcomed on the one hand by public health officials and experts, who described the 2% overall increase in 2022 as a “plateauing” of the death rate for this population, following a 56% spike between 2019 and 2021.
But at the same time, health officials noted that while drug and alcohol overdose deaths leveled off after significant increases between 2019 and 2021, overdoses from substance abuse remained the No. 1 cause of death among homeless people in 2022. In addition, the percentage of overdose deaths involving fentanyl, a synthetic form of opioid, continued to increase in 2022 among all racial and ethnic groups, and for both men and women.
The report only reflected data through 2022.
Will Nicholas, director of the Center for Health Impact Evaluation in the county’s public health department, said while the department is “cautiously optimistic” to see a flattening of the curve in overall deaths, it’s too soon to call it a trend.
“The mortality rate is still unacceptably high, but it is good to see a plateau,” Nicholas said during a news briefing with reporters. “In the future, our goal is to start to see that curve turning downwards.”
Between 2021 and 2022, the overall mortality rate increased 2% – from 3,215 per 100,000 people to 3,282 per 100,000 people.
“Each number in this report represents a person, a sister, a brother, a mother, a father, a child or someone’s friend,” said L.A. County Public Health Director Barbara Ferrer. “Each life lost needs to be a call to action for all of us.”
She said that while the mortality rate for homeless people plateaued, she’s concerned that there are still “staggering inequities” between people who are homeless and all other county residents.
“The continued gaps in health outcomes across the board for those housed and unhoused reminds us that people experiencing homelessness in our county lack the very basic resources and conditions that are essential for health and well-being,” Ferrer said.
Inequities persist
According to the report, in 2021 and 2022 combined, homeless people were nearly four times more likely to die than L.A. County’s overall population. That number has increased since the 2017-19 period when homeless people were about three times more likely to die.
In addition, the county saw increases for certain specific causes of death. In 2021 and 2022 combined, homeless people were 41 times more likely to die from an overdose and about 18 times more likely to die from traffic-related injuries or homicide, compared to all county residents.
“This report is cold comfort, and no one is celebrating a ‘plateauing’ in mortality rates,” Los Angeles County Supervisor Janice Hahn said in a statement. “Homelessness is deadly and, while we need to double down on harm reduction and street medicine programs, what we really need is to get people off the street and into safe housing.”
The top causes of death among the homeless population in 2021 and 2022 combined were: drug and alcohol overdose (37%), coronary heart disease (12%) and transportation-related injuries (8%).
Homicide and suicide rounded out the top causes of death in the homeless population in 2022, officials said.
They noted that while the overall suicide rate among homeless people has been relatively stable over the years, that rate nearly doubled between 2020 and 2022 among unhoused people aged 18 to 29, and that age group had the highest suicide rate in 2022.
Officials also noted that deaths caused by COVID-19 peaked in 2021, when it was the fifth leading cause of death among homeless people. But in 2022, the COVID-19 mortality rate dropped significantly and was no longer among the top 10 causes of death for unhoused people.
Recommended actions
Health experts on Thursday’s call attributed much of the leveling off of overdose deaths to greater access to naloxone, a medication that can quickly reverse the effects of an overdose, and other “harm reduction efforts.”
In addition to continuing to increase access to naloxone, the county’s public health department laid out a set of recommendations to further reduce deaths among homeless people.
They include:
Expand the range of permanent and supportive housing options available, including housing for people who are still using drugs.
Sustain and expand harm reduction and overdose prevention and response services.
Increase street-based engagement and outreach and drop-in spaces, and expand telehealth and mobile health services.
Expand access to comprehensive primary and preventive care, mental health and substance use services.
Support comprehensive wrap-around services to increase access to chronic disease management, including cardiac care.
Collaborate with municipalities and unincorporated communities to identify areas with high numbers of fatal injury collisions among homeless people so actions can be taken to prevent more traffic deaths.
This week’s report was compiled using data from the L.A. County’s medical examiner’s office and state death records as well as the Los Angeles Homeless Services Authority’s annual homeless count.
To view the full report, visit publichealth.lacounty.gov/chie.
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