In Los Angeles County (LAC), a total of 9,765 persons experiencing homelessness (PEH) died between 2014 and 2021. As the number of PEH across the county has increased with time, so have the total number of deaths among PEH which rose from 658 in 2014 to 2,201 in 2021. Likewise, mortality rates among PEH also increased, but with a more apparent change following 2019 when rates increased by 23% (2,671 per 100,000 population) in 2020 and by 55% in 2021 (3,183 per 100,000 population) (Figure 1). The steep increase in the death rate among PEH is alarming considering they were four times greater than the rate of death for LAC’s general population (CHIE).
In 2020-2021, 78% (n=4,012) of PEH deaths were attributed to accidental drug/alcohol (AOD) overdose, coronary heart disease, transportation-related injury, homicide, COVID-19, suicide, other unintentional injuries, and liver disease. Accidental AOD overdose deaths was the most common cause of death among PEH, accounting for over a third (37%) of all deaths (Figure 2). Overdose deaths has been a growing issue across LAC, but has notably affected the homeless population with deaths among PEH over 38 times greater than overdose deaths among the general LAC population (CHIE).
The rate of accidental AOD overdose deaths among PEH has been increasing each year since 2016. Rates gradually increased by 75% from 366 per 100,000 population in 2014, to 579 per 100,000 population in 2019, then quickly rose following 2019 by 70% in 2020 and then by 105% in 2021 (Figure 3). The drastic changes following 2019 possibly may be due the the stressors related to the COVID-19 pandemic.
Methamphetamine was the drug most identified in overdose deaths among PEH each year from 2018 to 2021. The percent of deaths were also high for fentanyl-involved deaths, which had increased by 367% from 2018 to 2021 and by 36% from 2020 to 2021 (Figure 4). By 2021 41% of all AOD overdose deaths among PEH were caused by a combination of drugs involving both fentanyl and methamphetamine.
Among overdose deaths in which a specific drug type was the sole cause of death, methamphetamine was the drug most identified as a cause of overdose death between 2018-2021. However, the percent of methamphetamine-only deaths began to decline after 2019, as did for heroin and cocaine, whereas fentanyl-only deaths gradually increased from 2.1% in 2018 to 6.6% in 2021 (Figure 5).
From 2017-2021, large increases in age-adjusted overdose mortality rates among PEH were observed for both male and females, but especially among males which were double that of rates for females each year. The age-adjusted rate of overdose death among males increased by 173% from 411 per 100,000 population in 2017 to 1,120 per 100,000 population in 2021. Among females, the age-adjusted death rate increased 134% from 2017 to 2020, then decreased in 2021 (Figure 6).
Age-adjusted AOD overdose mortality rates increased for all racial/ethnic groups between 2017-2021, with Whites having the highest mortality rate when compared to other racial/ethnic groups. However, the change over time was greatest among Blacks (320% increase from 188 to 788 per 100,000 population), followed by Latinx (by 151% from 331 to 830 per 100,000 population), then Whites (by 109% from 735 to 1,535 per 100,000 population) (Figure 7).
Los Angeles County Department of Public Health, Center for Health Impact Evaluation. Mortality Rates and Causes of Death Among People Experiencing Homelessness in Los Angeles County: 2014-2021. May 2023.
Los Angeles County Department of Public Health, Center for Health Impact Evaluation (CHIE). 2023. Mortality Among People Experiencing Homelessness in Los Angeles County – 2014-2021. http://publichealth.lacounty.gov/chie/docs/PEH_infographic2023.pdf.