A stark and heartbreaking reminder is evident in a new report covering ten years of records from deaths of people experiencing homelessness: The median age of death was 51. That compares to an overall median age of 79 for all deaths of King County residents.

These years of lost life reflect the forces and root causes that underlie homelessness itself.

The Report on Deaths Among Presumed Homeless Individuals Investigated by the King County Medical Examiner covers the years 2012-2021, and it includes an accompanying dashboard from Public Health — Seattle & King County.

It is a limited snapshot, not attempting to capture all deaths of people experiencing homelessness. The 1,429 deaths in this report were investigated by the King County Medical Examiner’s Office (KCMEO). That means they met the legal requirements for an investigation — those who died of sudden, unexpected, unnatural causes. In general, the KCMEO investigates less than 20 percent of all deaths in King County annually. (For most people, the cause of death is determined by a physician rather than a medical examiner.)

Yet, even when compared only to the deaths that met criteria to be investigated by the KCMEO, people who were homeless died an average of 11 years younger. 

The report shows a sad consistency across the past decade. Overall, there has been minimal year-to-year variation in ways that people died. The leading categories of deaths in the report include:

• Accidents (49%), ranging from overdoses to traffic-related deaths
• Natural causes (35%), including diseases such as cancer, heart disease, liver disease, and diabetes

Key findings include:

• More needs to be done to eliminate systemic racism as a root cause of homelessness. Painful and persistent disparities can be seen in the disproportionate number of deaths occurring among Black or African Americans and American Indian or Alaska Natives. The report describes how the deaths reflect the intersections of poverty, racism and geography.
• Housing and shelter save lives. The report documents 814 deaths that occurred outdoors, in vehicles, or other spaces not meant for human habitation. Research has found, the longer someone remains unsheltered and without access to care, the more likely they’ll die prematurely.

The deaths outdoors and from treatable medical conditions underscore the importance of bringing people indoors, with shelter and housing options that make health care accessible.

Role of overdoses among accidental deaths

Efforts to prevent overdoses – including outreach, education, access to overdose prevention medications, treatment, and needle exchange programs – are crucial to reducing deaths.

Drug overdose and poisoning cases represent 35% of deaths overall in the report, similar to the proportion due to natural causes. They account for 71% of accidental deaths. Overdose is also the most common type of accidental death among the broader/overall population of King County deaths investigated by KCMEO.

Over the past two years, the report shows a rise in deaths from drug overdoses among people presumed homeless. For example, fentanyl-related deaths of investigated cases increased from approximately 6% of investigated deaths in 2019 to 32% in 2021. (For more details on all overdose deaths, please see Public Health’s Overdose Deaths Dashboard.)

Weather, COVID-19 and trends

While this report does not show any patterns of deaths connected to severe weather events, it does suggest that current community efforts to help people experiencing homelessness plan for severe weather, along with the opening of emergency shelters, are vital. More than 90% of exposure deaths occurred between October and April. Overall, exposure was listed as the cause of 47 out of 1,429 deaths in the report (less than 5%), with hypothermia deaths increasing slightly over the past decade.

Among presumed homeless decedents, no significant change in the number of deaths could be attributed to the COVID-19 pandemic. Since identification of a case of COVID-19 requires diagnosis by a health care professional, any deaths occurring as a consequence of infection, by definition, would not fall under KCMEO jurisdiction as they could be certified by attending health professional. These deaths are described on the Homelessness and COVID-19 dashboard.

This report shows a trend between 2012 and 2021 toward increasing total annual numbers of presumed homeless deaths investigated by the KCMEO. This increase parallels increases in the overall number of KCMEO cases investigated, in King County’s total population, and in the number of people experiencing homelessness. While the number of investigated deaths has been increasing, the rate has remained relatively consistent at approximately 5% of all KCMEO investigated deaths.

Originally published 9/29/2022