As the number of PEH across LAC increased in recent years, so have the total number of deaths among PEH, which rose from 658 in 2014 to 2,201 in 2021. From 2014 to 2021 in Los Angeles County (LAC), there were a total of 9,765 deaths among persons experiencing homelessness (PEH).
Mortality rates per 100,000 population among PEH steadily increased from 1,596 in 2014 to 2,056 in 2019, then sharply increased to 2,671 in 2020 and to 3,183 in 2021 (Figure 1). The current death rates among PEH is alarming, considering they are four times greater than that of LAC’s general population (CHIE).
Of the 4,012 PEH deaths occurring in 2020-2021, 78% were attributed to 8 major causes of death (in order): Accidental drug/alcohol (AOD) overdose, coronary heart disease, transportation-related injury, homicide, COVID-19, suicide, other unintentional injuries, and liver disease. Accidental AOD overdose accounted for over a third (37%) of all PEH deaths (Figure 2). Overdose deaths has been a growing issue across LAC, but has especially affected the PEH population, with the rate of overdose deaths among PEH over 39 times greater than that among the general LAC population in 2020-2021(CHIE).
From 2014 to 2021, the rate of AOD overdose deaths among PEH per 100,000 population increased by 260%. Rates increased steadily from 330 in 2014 to 579 in 2019, then jumped to 982 in 2020, and to 1,189 in 2021 (Figure 3). The drastic changes following 2019 may possibly be due to the stressors related to the COVID-19 pandemic.
Methamphetamine was the drug most frequently involved in AOD overdose deaths among PEH each year from 2018 to 2021, increasing from 63% to 77%. Fentanyl was also increasingly involved in AOD overdose deaths among PEH, increasing by 367% from 13% in 2018 to 58% in 2021 (Figure 4).
Among PEH overdose deaths involving a single drug, methamphetamine was the drug most frequently identified as the cause of overdose death between 2018-2021. While the percent of PEH overdose deaths involving only methamphetamine began to decline after 2019, as it did for heroin only and cocaine only, fentanyl-only deaths gradually increased from 2.1% in 2018 to 6.6% in 2021 (Figure 5).
Multi-drug use was the norm among PEH. In 2021, 71% of all fentanyl involved deaths among PEH also involved methamphetamine, and 41% of all AOD overdose deaths among PEH were caused by drug combinations that included both fentanyl and methamphetamine in 2021 (CHIE).
From 2020 to 2021, the rate of AOD overdose deaths increased for PEH of all age groups, with particularly large increases among adults 70+ years (by 58%) and adults 60-69 years (by 36%).
In 2021, AOD overdose rates were highest among those aged 60-69 years (rate=1,710) and 50-59 years (rate=1,550) (Figure 6).
The age-adjusted AOD overdose mortality rates per 100,000 population among male PEH was double that of female PEH in 2021.
From 2017-2021, large increases in age-adjusted overdose mortality rates among PEH were observed for both genders, especially for males which increased by 173% from 411 in 2017 to 1,120 in 2021, while for females the age-adjusted death rate increased 134% from 253 in 2017 to 592 in 2020, then decreased 6% to 559 in 2021 (Figure 7).
Whites had the highest age-adjusted mortality rates per 100,000 population compared to other racial/ethnic groups during all years in 2017-2021.
Age-adjusted AOD overdose mortality rates increased for all racial/ethnic groups between 2017-2021. The increase during the period was greatest among Blacks (320% increase from 188 to 788), followed by Latinx (by 151% from 331 to 830), then Whites (by 109% from 735 to 1,535) (Figure 8).
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.