Deaths of profound despair: A retrospective cohort study of mortality among people experiencing homelessness

• Published in: PloS one Vol. 18; no. 2; p. e0281912
• Main Authors: Chang, Jamie Suki, Saxton, Katherine, Bright, Georgia, Jorden, Michelle A, Gutierrez, Andy, Xia, Katherine
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.02.2023; Public Library of Science (PLoS)
• Subjects: Autopsies; Biology and Life Sciences; Cause of Death; Chronic illnesses; Cohort analysis; Death; Death & dying; Drug use; Earth Sciences; Fatalities; Health services; Homeless people; Homelessness; Homicide; Hopelessness; Housing; Humans; Ill-Housed Persons; Illnesses; Injuries; Injury prevention; Liver diseases; Local government; Medicine; Medicine and Health Sciences; Mental health; Middle Aged; Minority & ethnic groups; Mortality; Mortality patterns; Physical Sciences; Poisoning; Population; Public health; Research and Analysis Methods; Residential patterns; Retrospective Studies; Social Sciences; Socioeconomic factors; Substance abuse; Substance use; Suicide; Trends; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0281912

The number of people dying while unhoused is increasing nationally. In Santa Clara County (SCC), deaths of unhoused people have almost tripled in 9 years. This is a retrospective cohort study examining mortality trends among unhoused people in SCC. The objective of the study is to characterize mortality outcomes in the unhoused population, and compare these to the SCC general population. We obtained data from the SCC Medical Examiner-Coroner's Office on unhoused people's deaths that occurred between 2011-2019. We analyzed demographic trends and cause of death, compared to mortality data on the SCC general population obtained from CDC databases. We also compared rates of deaths of despair. There were a total of 974 unhoused deaths in the SCC cohort. The unadjusted mortality rate among unhoused people is higher than the general population, and unhoused mortality has increased over time. The standardized mortality ratio for unhoused people is 3.8, compared to the general population in SCC. The most frequent age of death among unhoused people was between 55-64 years old (31.3%), followed by 45-54 (27.5%), compared to 85+ in the general population (38.3%). Over ninety percent of deaths in the general population were due to illness. In contrast, 38.2% of unhoused deaths were due to substance use, 32.0% illness, 19.0% injury, 4.2% homicide, and 4.1% suicide. The proportion of deaths of despair was 9-fold higher in the unhoused cohort compared to the housed cohort. Homelessness has profound impacts on health, as people who are unhoused are dying 20 years younger, with higher rates of injurious, treatable, and preventable causes, than people in the general population. System-level, inter-agency interventions are needed. Local governments need to systematically collect housing status at death to monitor mortality patterns among unhoused people, and adapt public health systems to prevent rising unhoused deaths.