Number of People Experiencing Homelessness (PEH) who Died in Los Angeles County More than Doubled during the Past Five Years

Number of PEH who died by accident more than doubled.
Number of PEH who died by homicide more than doubled.
Number of Black PEH who died more than doubled.
Number of Hispanic/Latin(o)(a)(x) PEH who died more than doubled.

California Assembly Bill 271 Homeless Death Review Committees, if approved during the 2023 legislative session would, authorize counties to

• Establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population; and
• Develop a protocol to be used as guidelines by persons performing autopsies on homeless individuals to assist coroners and other persons who perform autopsies in the identification of the cause and mode of death of the individual.

The Action Plan for Preventing and Ending Homelessness in California was recently updated and designated the Department of Public Health to

• Enhance the availability of data regarding mortality among people experiencing homelessness, through technical assistance and data collection activities to ensure such information is reflected on death certificate data provided to the state from counties, and use the data collected to inform and strengthen public health interventions to reduce such mortality.

This report is based on publicly accessible mortality data from the Los Angeles County Department of the Medical Examiner-Coroner (MEC). Acquired data from the Public Services Division between 2018 and 2022 reveals that the number of people noted as “indigent-homeless” under “type of residence” increased significantly.

A person classified as “indigent-homeless” did not have an established residence or the person was found in a location that suggested homelessness such as an encampment, field, park, alley, and sidewalk.

Chart 1 shows the number of people who died while homeless in Los Angeles County in 2022 was 1,692 and 806 in 2018 representing an increase of 886 people or 110%.

Chart 2 shows that the number of people who died because of accidents and homicide more than doubled between 2018 and 2022.

The number of people who died by accident was 962 in 2022 and 430 in 2018 representing an increase of 532 people or 124%.

The most common cause of death by accident was multiple or mixed drug toxicity including cocaine, ethanol, fentanyl, heroin, methadone, and methamphetamine. The next common cause was blunt force trauma including multiple injuries and head injuries. Other accidents included infections, septic shock, smoke inhalation, environmental exposure, sudden cardiac death, and drowning.

The number of people who died by homicide was 133 in 2022 and 66 in 2018 representing an increase of 67 people or 102%.

The manner of homicide included gunshot wounds, stab wounds, blunt force injuries, and strangulation.

When looking at gender, the LA County Medical Examiner Coroner’s (MEC) Office files only note male or female under gender.

Chart 3 shows that the number of males who died in 2022 was 1,400, and the number of males who died in 2018 was 637 representing an increase of 763 persons or 120%.

The chart also shows that the number of females who died in 2022 was 289, and the number of females who died in 2018 was 169 representing an increase of 120 persons or 71%.

The MEC, under race and ethnicity, notes Black, Hispanic/Latin American, and Caucasian as three of the racial groups listed. However, the chart below notes Black, Hispanic/Latin(o)(a)(x), and White.

Chart 4 shows that the number of Black and Hispanic/Latin(o)(a)(x) PEH who died more than doubled between 2018 and 2022.

The number of Black PEH who died in 2022 was 452 and 187 in 2018 representing an increase of 265 PEH or 142%.

The number of Hispanic/Latin(o)(a)(x) PEH who died in 2022 was 629 and 262 in 2018 representing an increase of 367 PEH or 140%.

The number of White PEH who died in 2022 was 540, and 317 in 2018, representing an increase of 223 PEH or 70%.

Chart 5 shows that

• Black PEH comprised 23% of the total number of PEH who died in 2018 and 27% in 2022.
• White PEH comprised 39% of the total number of PEH who died in 2018 and 32% in 2022.
• Hispanic/Latin(o)(a)(x) PEH comprised 33% of the total number of PEH who died in 2018 and 37% in 2022.

What Next

AB 271 Homeless Death Review Committees if approved during the 2023 legislative session would authorize counties to

• establish a homeless death review committee for the purposes of gathering information to identify the root causes of death of homeless individuals and to determine strategies to improve coordination of services for the homeless population. The bill would establish procedures for the sharing or disclosure of information by a homeless death review committee.
• establish a homeless death review committee pursuant to subdivision (a) may develop a protocol to be used as guidelines by persons performing autopsies on homeless individuals to assist coroners and other persons who perform autopsies in the identification of the cause and mode of death of the individual.

The Action Plan for Preventing and Ending Homelessness in California was recently updated and designated the Department of Public Health to

• Enhance the availability of data regarding mortality among people experiencing homelessness, through technical assistance and data collection activities to ensure such information is reflected on death certificate data provided to the state from counties, and use the data collected to inform and strengthen public health interventions to reduce such mortality.

The findings in this report add to the urgency to carry out the recommendations included in Mortality among People Experiencing Homelessness in Los Angeles County: One Year Before and After the Start of the COVID-19 Pandemic.

The report detailed 20 recommendations that focused on

• Enhancing and expanding field-based substance use disorder and other health care treatment;
• Expanding and improving substance use disorder services;
• Expanding peer-based outreach through street-based syringe exchange and overdose prevention education;
• Expanding and enhancing county-contracted substance use disorder provider utilization of the Homeless Management Information System (HMIS) to improve coordination of care and housing-focused case management;
• Increasing investments in recovery bridge housing;
• Implementing infectious disease protocols in encampments;
• Continuing annual surveillance of mortality among persons experiencing homelessness in LA County including a geographic analysis of traffic injury and homicide deaths, and review a subset of deaths in more depth; and
• Conducting analysis of administrative data records of deceased persons experiencing homelessness in coordination with County departments and academic partners, to reduce homeless mortality.

To read the report click here.

Recommended Action for Next Steps

Step 1. Create a State Repository for De-identified Records of Persons who Died Homeless

The State of California should create a repository of all records for persons who died while homeless, according to MEC offices. Integrating the repository data into HDIS would provide an unprecedented opportunity to create new, or improve existing, planning and policies and increase temporary and permanent housing and services for persons languishing on the streets prone to injury and death.

Integrating the repository data could help, among other proactive actions,

• Determine what steps can be taken to prevent the loss of life. Information from Coroner records can raise awareness of problems such as the high incidence of blunt force trauma by vehicles and trains;
• Signal a larger public health emergency such as infectious diseases including Hepatitis C. Some California counties have recently declared a local health emergency as a result of an outbreak of Hepatitis C that resulted in some deaths;
• Discover if a week of the month or month of the year has the highest death rates in order to heighten street outreach and other outdoor interventions during a critical period of time; and
• Decide if there are types of locations such as open areas like parks and fields, freeway underpasses, and industrial zones in cities and zip codes where higher concentrations of persons die homeless in order to heighten street outreach and other outdoor interventions within such locations.

However, at this time, tracking and reporting mortality is a complex and decentralized process with various systems used by California MEC offices. Some uniformity should be required prior to the creation of the repository that includes:

• Using a common definition of homelessness to determine homelessness;
• Phasing out any paper-based systems and replaced with reputable software; and
• Upgrading any outdated electronic systems.

Step 2. Integrate Medical Examiner-Coroner’s (MEC) Records of Persons Who Died While Homeless into HDIS

The Homeless Data Integration System (HDIS) is a technological solution that allows the State of California

“to access and compile standardized homelessness data collected (Homeless Management Information System) by individual Continuums of Care (CoCs) in order to make data-driven policy decisions aimed at preventing and ending homelessness in California.”

and

“develop(s) a variety of de-identifiable data tools (e.g., aggregate reports, dashboards, ad hoc analyses) to better understand the demographic characteristics and patterns of homelessness; to inform policy, program, and funding decisions; and to educate the California public about the nature and scope of homelessness. All publicly available data tools will be composed only of de-identified aggregate data and will not contain personal information.”

HDIS also positions the State

“to solve a problem that it does not have the data to fully understand” and “align State resources more effectively and efficiently with the needs of local communities,” as noted by an expert in HMIS during a presentation focused on Exploring Development of a California Homeless Data Integration System.

In California, the MEC Office’s responsibilities include tracking and reporting mortality information that involves determining the manner of death, injury description, causes of death, and residency. Basic demographic data, such as gender, race, and age, are also recorded. This information is often used collectively to provide insights into health threats and disparities, improve outbreak and disaster response efforts, and expose circumstances surrounding sudden, unexpected, and unnatural deaths. This information is also used to compare death trends between cities and counties.

A close look at residency information for the deceased reveals that MEC Offices classify a significant number of persons as “homeless” or “transient.” A close look at the manner of death, injury description, and causes of death reveals that homelessness is much more than the absence of physical housing; as we have noted before, it is a tension-filled, trauma-filled, and treacherous condition that often results in injuries and fatalities.

Past examinations by MEC staff throughout the state have determined that thousands of homeless persons have died under many circumstances, e.g., electrocution, thermal injuries, hypothermia, environmental exposure, drug overdose, and blunt force injuries, including traffic accidents, among others. MEC staff record the manner of death, which includes accidents, natural causes, homicide, and suicide. Accidents have involved drug overdose, environmental exposure, structural fires, and traffic and blunt force injuries involving vehicles and trains. Natural causes have included heart disease, hepatitis C, HIV/AIDS, and a wide range of other illnesses and diseases.

Thus, integrating statewide MEC Office data into HDIS would provide an unprecedented data to help improve planning, policy, and services regarding homelessness and mortality prevention statewide. We would be able to answer questions that we have never been able to answer before about dying on the streets while homeless.