Mortality rates among homeless people in L.A. County were released; here’s what you need to know

“Unacceptably high“ is what the Los Angeles County Department of Public Health (CDPH) used to describe the mortality rate among people experiencing homelessness in Los Angeles County.

On Thursday, May 9, CDPH held a virtual press conference to officially present the most recent data and findings of their fifth annual report on mortality among the homeless population in the county. 

These annual reports use data from the LA County Office of Medical Examiner and California state death records to estimate the number of deaths among people experiencing homelessness, as well as data from the annual L.A. County point-in-time homeless count and demographic survey to estimate the numbers of people experiencing homelessness along with their demographic characteristics. 

The report, which assessed the years 2021–2022, found that the overall mortality rate among those who are homeless in L.A. County increased by 2% from 3,215 per 100,000 people to 3,282 per 100,000 people. Previously, during the 2019–2021 period, the increase was much higher. During these years, mortality rates increased by 56%.

“There are staggering inequities in health outcomes between those who are housed and those who are homeless,” L.A. County Health Director Barbara Ferrer said on Thursday. “People experiencing homelessness are 40 times more likely to die of an overdose, 18 times more likely to be a homicide victim and four times more likely to die of coronary heart disease than people in L.A. County's population as a whole.”

Although the mortality rate has only increased 2% from 2021–2022, showing a stabilization and evening-out in the overall mortality rate, the CDPH said they remain “cautiously optimistic.”

“The mortality rate is still unacceptably high, but it is good to see a plateau [in the data]…In the future, our goal is to start to see the curve tuning downward,” Will Nicholas, director of the DPH Center for Health Impact Evaluation, said. 

For the last six years, the top cause of death among homeless individuals in L.A. has been drug overdoses, accounting for 37% of all deaths in 2022, with the epicenter being in Skid Row, followed by coronary heart disease, accounting for 12% of deaths, which is caused by plaque buildup in the walls of the arteries that supply blood to the heart. The third leading cause of death are traffic-related incidents, accounting for 8% of deaths).

Nicholas said that in the last couple of years, there has been a traffic death every other day among people experiencing homelessness in L.A. County.

“We know that 95% of those traffic deaths are among pedestrians and cyclists, and about two thirds of them occur at night,” Nicholas added. 

The leveling off of the rate of drug overdose deaths can be attributed largely to the 2021–2022 distribution of doses of naloxone, an opioid overdose reversal medication. Despite the recent leveling off of the overdose mortality rate among people experiencing homelessness, the risk of fentanyl overdose is very high among unhoused people who use drugs. The percentage of overdose deaths involving fentanyl continued to rise through 2022 for all racial and ethnic groups, including Latinos, as well as for both males and females. 

Unlike the other causes of death, there is one that has been increasing at an alarming rate: homicide, the fourth leading cause of death, with a rate of 214 per 100,000 people in 2022, the highest rate since these trends have been monitored. The proportion of homicide deaths was more than twice as high among males compared to females and was two to three times higher among Black and Latino unhoused people compared to white people. 

Another alarming figure presented at Tuesday's press conference was that of suicides. Although the overall suicide rate among people experiencing homelessness has remained relatively stable over time, the suicide rate almost doubled among young adults from 2020 to 2022. The report shows that unhoused people aged 18–29 in 2022 were the age group with the highest suicide rate.

“Year after year, we continue to see the impacts of substance use on our unhoused neighbors. As the leading cause of death among people experiencing homelessness, it is critical that the county continue to invest in solutions that meet the needs of this community. That is why I am working to open a Harm Reduction Health Hub on Skid Row, the epicenter of the overdose crisis, to ensure residents get the resources they need to address this behavioral health crisis,” said Supervisor Hilda L. Solis in a statement.

When it comes to Latinos, the latest data showed that the mortality rates among this group actually decreased significantly, but Nicholas clarified that this is only because the number of Latinos that fell into homelessness from 2020–2022 increased by outstanding rates, due to the economic hardship caused by the COVID-19 pandemic. “As you can imagine, if the total population increases, then your mortality rates also go dow These new entries to homelessness in this population were largely more healthy, younger and many were living in cars,” Nicholas said. Despite that, Nicholas said the CDPH will continue to follow this trend closely. 

In collaboration with community partners, CDPH also listed several recommendations and actions that could help reduce the disproportionate rate of mortality among unhoused individuals. Some of the recommendations included ensuring unhoused individuals are linked to housing options aligned with their individual needs, which will require regular;y training staff members of different community and county groups providing outreach and engagement services.

Expanding harm reduction and overdose prevention through legislation, regulation, local engagement and advocacy was also a recommendation to help prioritize residents experiencing homelessness. 

"I'm excited about the recommendations because they continue to move forward with interventions that will work. The report clearly shows that you can demonstrate each plateau is connected to actual interventions,” Veronica Lewis, director of the Homeless Outreach Program Integrated Care System, said. 

Another recommendation is for the county and its partners to help sustain and expand the range of permanent and supportive housing options, ensuring people who use drugs will not lose their housing due to substance use. 

“After alarming increases in drug-related overdoses over the past several years, it is encouraging to see a slowing of this leading cause of death for people experiencing homelessness. Efforts to increase access to naloxone and overdose prevention services have undoubtedly helped to bend this curve and provide a blueprint for reducing drug-related fatalities in this very high-risk population,” said Dr. Gary Tsai, Director of the Bureau of Substance Abuse Prevention and Control. “Given that the opposite of addiction is not sobriety, but rather meaningful connection, continuing to engage and build trusting relationships with our unhoused residents will be equally essential.”

The next report is expected to be released in early 2025 and will include data through 2023.

To view the full report online, visit: http://publichealth.lacounty.gov/chie/