The Los Angeles County Department of Public Health released its sixth annual report on homeless mortality, revealing that death rates among the unhoused population have plateaued for a second consecutive year. In 2023, 2,508 people experiencing homelessness died in Los Angeles County, with the mortality rate remaining high at 3,326 deaths per 100,000 people. This represents just a 1% increase from 2022, following a 2% increase the previous year and a devastating 56% surge from 2019 to 2021.
"As the County continues to grapple with the worst overdose crisis in its history, the plateau in the mortality rate among people experiencing homelessness is a clear reminder of the challenges we continue to face in tackling this crisis," said Hilda L. Solis, Los Angeles County Chair Pro Tem and Supervisor for the First District.
The stabilization is largely attributed to a leveling of drug overdose mortality from 2022 to 2023, supported by a three-fold increase in naloxone distribution during that period. Overdose remains the leading cause of death, accounting for 45% of all deaths among unhoused individuals. Although the percentage of overdose deaths involving fentanyl has begun to plateau, it still represents 70.4% of cases.
Coronary heart disease persists as the second leading cause, responsible for 14% of deaths, with a concerning 22% increase in the heart disease mortality rate from 2022 to 2023 -- the largest increase recorded since 2016. This increase was observed among males and females and among White and Latino people experiencing homelessness, but not among Black people.
Transportation-related injuries remained the third leading cause of death, with rates plateauing but still 50% higher than in 2019. On average, a person experiencing homelessness was killed by a moving vehicle in Los Angeles County approximately every other day, with 95% of those deaths occurring among pedestrians and cyclists.
The homicide rate decreased by 25% from 2022 to 2023, a welcome reduction after years of increases since 2019. The decrease was particularly notable among Black people experiencing homelessness, among whom the percentage of deaths from homicide dropped from 8% to 4%.
The rate of suicide, the fifth leading cause of death, has remained relatively stable over time. Suicide rates have been consistently higher among younger people experiencing homelessness and among White and Latino people experiencing homelessness.
After peaking in 2021 at 204 deaths per 100,000 people, the COVID-19 mortality rate among people experiencing homelessness has rapidly declined, continuing to decrease in 2023.
These annual reports use data from the Los Angeles County Office of the Medical Examiner and California state death records to estimate numbers of deaths among people experiencing homelessness, as well as data from the annual Los Angeles County point-in-time homeless count and demographic survey. The next report, to be released in early 2026, will include data through 2024.
2023 was the first full year of implementation of a new procedure for recording homelessness in the State Electronic Death Reporting System. A special analysis shows this improved accounting mechanism may have helped increase the identification of homeless decedents who died of natural causes in hospitals and nursing homes.
"This report reinforces that shortening the timeframe people experience homelessness is a matter of life or death, which is why we need to urgently achieve Functional Zero across LA County," said Holly J. Mitchell, Los Angeles County Supervisor for the Second District. "The plateau in mortality rates lets us know that maintaining rapid housing services, robust preventive and treatment services, and investing in poverty alleviation helps save lives and keeps people from becoming unhoused in the first place."
In 2023, people experiencing homelessness were 4.5 times more likely to die than the general Los Angeles County population, an increase from 3.8 times in 2022. Mortality disparities were most severe among White unhoused individuals (seven times higher than housed White people), followed by Latinos (4.8 times) and Black residents (2.7 times).
"Homelessness is deadly. And while this plateau is better than an increase, even one person dying on our streets is one too many," said Janice Hahn, Los Angeles County Supervisor for the Fourth District. "Getting people out of encampments and into shelters saves lives and we should double down on harm reduction and preventing overdoses."
"Our ability to improve health outcomes among people experiencing homelessness depends on understanding what focused actions are needed to reduce the disproportionate burden of mortality among this vulnerable population," said Barbara Ferrer, Ph.D., M.P.H., M.Ed., Director of the Los Angeles County Department of Public Health. "We must continue and expand the implementation of the strategies recommended in the report to significantly reduce the disproportionality in mortality rates and ensure the health and well-being of all Los Angeles County residents experiencing homelessness."
"Despite the continued plateau in drug related overdoses among people experiencing homelessness, we are still facing the worst overdose crisis in history," said Dr. Gary Tsai, Director of the Bureau of Substance Abuse Prevention and Control. "Expanding access to treatment, overdose prevention, and harm reduction services has been vital to this progress, but our work is far from over. Now more than ever, we must continue our efforts to provide lifesaving services to high-risk populations and foster the trust needed to continue reducing drug-related fatalities."
Public Health recommends four key actions to reduce mortality among unhoused individuals: ensuring rapid access to housing and shelter that are responsive to the needs of Los Angeles County residents experiencing homelessness; expanding harm reduction and overdose prevention outreach, engagement, and response, prioritizing those at highest risk; ensuring that physical health, mental health, and substance use treatment services are available and responsive; and collaborating with municipalities and unincorporated communities to reduce traffic deaths.
It's worth noting that the earlier reporting of a plateau in overdose mortality in 2022 has been revised. This revision occurred after an unusually high number of unexplained causes of death in the provisional death file for 2022 were belatedly assigned causes (mostly drug-overdoses) after a backlog of medical examiner cases requiring toxicology testing was cleared.