Without shelter, people die: disproportionate mortality rates among King County’s homeless population, 2009 - 2019

Abstract

People living without benefit of decent housing suffer from a wide range of life-shortening health conditions and die younger than the general population. We created a dataset constructed from an ongoing list of homeless decedents who died in King County, maintained by a Seattle advocacy organization (Women’s Housing Equality and Enhancement League), and the King County Medical Examiner’s death certificate data, supplemented by in-depth mortality case notes. Medical and contextual information were reviewed and cross-checked to ascertain causes and modes of death for each case. The dataset for this study includes decedents who were presumed to be homeless upon death, and who died in King County between 2009 and 2019. Data were analyzed to observe cause-specific mortalities by year and compare to Washington state’s general population. The average age at death among decedents in our study was 48.9, in comparison to the Washington state life expectancy of 80.3 years. Using the annual Point in Time Count as our denominator, we estimated the non-age-adjusted all-cause mortality rate among King County’s homeless population to be, on average, 1.5x that of the general population for the eleven-year period. Homicide rates were, on average, 19x higher among homeless than the general population, and suicide was 5.5x times higher than the general population. Roughly one-third of deaths were attributed to “natural causes” and another one-third to drug or alcohol acute intoxication. Mortality rates trended upward over time for the homeless population, while rates for the general population remained stable over the study period. Our study fills a gap in the literature about the high rates of death and disproportionate causes among those living on the streets of one of the wealthiest regions of the nation. Our project also offers a blueprint for how other counties can comprehensively track and report homeless deaths. Revealing the magnitude and causes of deaths for this vulnerable population may motivate policy change.