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Sharp rise in mortality rates among LA County homeless


Driven by fentanyl, traffic deaths, homicides

The Los Angeles County Department of Public Health has released its fourth annual report on mortality among people experiencing homelessness in Los Angeles County. The mortality rate, which accounts for the total number of people experiencing homelessness each year, increased by 55%, from 2,056 per 100,000 in 2019 to 3,183 per 100,000 in 2021, the most recent years of data analyzed in this report.

In 2019, 1,289 people experiencing homelessness died. This number increased to 1,811 in 2020 and 2,201 in 2021.

Drug overdose was, as in 2019, the leading cause of death for people experiencing homelessness, accounting for 37% of all deaths among unhoused individuals in 2020 and 2021 combined —about two deaths per day on average. Drug overdose was also the largest driver of the overall increase in mortality for people experiencing homelessness, with the overdose mortality rate doubling from 2019 to 2021.

The second leading cause of death continues to be coronary heart disease, although the coronary heart disease mortality rate decreased in 2021 after increasing from 2017 to 2020.  Coronary heart disease deaths accounted for 14% of all deaths among persons experiencing homelessness in 2020 and 2021 combined– about 5 deaths per week on average.

The third leading cause of death was traffic injuries, which increased by 47% from 2019 to 2021, accounting for 8% of all deaths of people experiencing homelessness in 2020 and 2021 combined —about 3 deaths per week on average.

The homicide rate, which has risen among people experiencing homelessness since 2017, increased by 49% in 2021 compared to the previous year. Homicides were the fourth leading cause of death in 2020 and 2021—about 2 deaths per week on average.

COVID-19 was the fifth leading cause of death among people experiencing homelessness in 2020 and in 2021..

Fentanyl has been the drug type driving overdose deaths since the start of the pandemic, with the percentage of overdose deaths involving fentanyl almost tripling from 20% in 2019 to 58% in 2021. Fentanyl deaths almost always involved combinations of drugs. In 2021, 71% of all fentanyl deaths among people experiencing homelessness also involved methamphetamine.

For the combined years of 2020 and 2021, the mortality rate among people experiencing homelessness was 3.8 times greater than that of LA County residents. This represents a widening of the mortality gap since the three-year period prior to the pandemic when the mortality rate for people experiencing homelessness was 2.9 times greater.

In 2020-21, overdose mortality was 39 times greater among people experiencing homelessness when compared to LA County residents. Traffic injury and homicide mortality were, respectively, 20 and 15 times greater among people experiencing homelessness during the first two years of the pandemic, than among all other county residents.

“We have declared a state of emergency in Los Angeles County because there are far too many people on our streets,” said Supervisor Hilda Solis, co-author of the 2019 motion addressing rising homeless mortality. “The findings in this report reflect the urgency with which we must work to protect the most vulnerable among us.”

“This is a tragedy upon a tragedy,” said Supervisor Janice Hahn, chair of the Los Angeles County Board of Supervisors. “People are dying on our streets and this report only underscores how important it is that we continue to treat the homelessness crisis with a sense of urgency and move as many people as possible inside so we can begin to save their lives.”

“This report underscores the enormous destruction fentanyl is causing our communities. To know that people experiencing homelessness are 39 times more likely to die of a drug overdose compared to the overall population of LA County is yet another painful reminder of the harm our unhoused neighbors experience, and why we must continue to move with urgency to address the crisis on our streets,” said Supervisor Lindsey P. Horvath.

“The data from this report quantifies what we already intuitively know to be true: more people experiencing homelessness on our streets are suffering and dying,” said?Supervisor Kathryn Barger. “Substance abuse is many times an attempt to mask and escape trauma. Our homeless are fighting a losing battle and need help. They aren’t going to heal themselves without proactive support. The county’s role is to provide services and we need to answer that call, without barriers or hesitation.”

“Being homeless has always been associated with a greater risk of death; in this report, we see how big the mortality gap is between those housed and unhoused. For every leading cause of death in LA County, unhoused individuals are between two and 40 times more likely to die than those not experiencing homelessness,” said Barbara Ferrer, director of the Los Angeles County Department of Public Health.

Among the plans to help prevent homeless deaths are:

– Expanding and improving field-based, harm reduction-oriented substance use disorder   treatment services.

–Increasing distribution of naloxone to people experiencing homelessness in the street;

– Expanding and enhancing County-contracted substance-use disorder provider utilization of the homeless management information system to improve coordination of care;;

–Increasing investments in recovery bridge housing;

–Increasing the provision of preventive healthcare and chronic disease management;

–Collaborating with local jurisdictions to identify concentrations of fatal injury collisions involving people who are unhoused.