The death rate for unhoused Angelenos remained relatively flat in 2023, and experts point to increased availability of anti-overdose medication being a potential factor, according to a report released Thursday by the L.A. County Department of Public Health.
The mortality rate rose just 1% in 2023, the most recent year for which data is available. That’s about 2,500 deaths of unhoused people in Los Angeles County that year, 45% of which were caused by drug overdoses.
On average, nearly seven people experiencing homelessness died each day in L.A. County in 2023.
In 2022, there were 2,374 unhoused deaths in L.A. County.
In previous years, there had been steep increases in deaths of unhoused people — a 56% increase between 2019 and 2021 — driven largely by a rapid rise in fentanyl overdoses. Since then, there have been efforts to make naloxone, a drug that can reverse the effects of opioid overdose, more widely available in libraries, jails and other spaces.
This year’s report credits expanded distribution of naloxone, known by the brand name Narcan, as likely helping prevent further dramatic increases. But drug-related deaths are still a major concern.
“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 county Public Health’s Bureau of Substance Abuse Prevention and Control, at a Thursday morning news conference.
Drug overdoses remain the leading cause of death for the region's unhoused population, and the drug overdose mortality rate among homeless Angelenos is nearly three times higher than it was in 2019.
Fentanyl was involved in 70% of drug-related fatalities in 2023, the report states, compared with 68% the previous year.
Coronary heart disease was the second leading cause of death, increasing significantly in 2023. Transportation-related injuries remained the third leading cause, with an unhoused pedestrian or cyclist dying about every other day.
The deadliest locations for unhoused Angelenos included downtown/Skid Row and Westlake/MacArthur Park, according to geographic analysis.
Reaction from county leaders
County government leaders appeared to be encouraged by some the findings in the report. Some said a plateau in the mortality rate is evidence that investments in housing and treatment for unhoused people were working.
Supervisor Hilda Solis said in a statement that she is well aware of the need for safe housing, mental health services and substance-use programs. Her district includes Skid Row and MacArthur Park.
Nearly 7 unhoused LA County residents died each day in 2023
“While it’s encouraging to see the overdose deaths and other major causes of death start to level off, we can’t stop here,” Solis said.
Supervisor Janice Hahn seems to agree.
"Getting people out of encampments and into shelters saves lives, and we should double down on harm reduction and preventing overdoses,” she said.
The Public Health Department offered more than a dozen recommendations for reducing homeless mortality in L.A. County, including expanding housing options for people who use drugs, increasing harm reduction services, improving access to cardiac care and collaborating with cities to curb traffic deaths.
By the numbers
Between 2013 and 2023, L.A. County’s homeless population nearly doubled to more than 75,000 people. In that time, the number of deaths of unhoused people increased every year, as did the overall mortality rate for the unhoused population.
That means as L.A. County’s unhoused population has grown, it also became even deadlier to experience homelessness in the region.
Overall, unhoused residents died at 4.5 times the rate of the general population in 2023. Their rate of drug overdose mortality was 49 times higher, and their rate of transportation-related death was 20 times higher.
Causes of Death
The top five causes of death have consistently been drug overdose, coronary heart disease, transportation-related injury, homicide and suicide, except in 2020 and 2021 at the height of the COVID-19 pandemic.
In 2023, those five causes made up 75% of all deaths among people experiencing homelessness in the region, according to L.A. County’s Department of Public Health.
1. Drug overdose
Drug and alcohol overdoses have been the leading cause of death since 2017, according to county data. The overdose mortality rate spiked dramatically between 2019 and 2022, before leveling off in 2023. Methamphetamine overdoses were the biggest cause of overdose death, followed by fentanyl.
“I think it's so important that we don't allow this data to let us become complacent,” said Trevor Lee, medical director of the harm reduction division at L.A. County’s Department of Health Services. “We are still in the midst of the worst overdose crisis in history, which is disproportionately affecting people experiencing homelessness.”
Health officials say increased distribution of naloxone, as well as other harm reduction, overdose prevention and substance use treatment services helped reduce the number of overdose deaths related to fentanyl and other opioids. In 2020, L.A. County service providers handed out 48,000 doses of naloxone. Last year, it was nearly 480,000 doses.
Still, the risk of fentanyl overdoses remains high among unhoused Angelenos who use drugs. The percentage of overdose deaths involving fentanyl increased to 70% in 2023, from 13% in 2018. That was similar to the previous year.
“It's so important that we interpret these results by identifying what's working and then doubling down on those efforts so that we can actually begin to see a decrease in deaths, because the plateau is not not good enough,” Lee said.
Methamphetamine was involved in 79% of overdose deaths. Most overdose deaths involve more than one drug, and more than half involved both fentanyl and methamphetamine in 2023, according to county officials. Cocaine was involved in 15% of overdose deaths, and heroin in 5%.
2. Coronary heart disease
The second leading cause of death among L.A.’s unhoused population continues to be coronary heart disease, which accounted for 14% of deaths in 2023. The rate for this cause of death rose 22% between 2022 and 2023 — the largest increase recorded by L.A. County health officials since 2016.
The rate was nearly six times greater among unhoused L.A. County residents than in L.A. County generally.
Previous reports have pointed out that unhoused people in L.A. die from coronary heart disease at much younger ages than people who are housed. In 2022, the average age at death from coronary heart disease among the unhoused was 64, compared to 78 for all L.A. County residents.
3. Transportation-related deaths
In 2023, an unhoused pedestrian or cyclist was killed by a moving vehicle approximately every other day in L.A. County. But homeless Angelenos were 20 times more likely to die from transportation-related injuries than L.A. County residents overall.
People experiencing homelessness are more vulnerable to traffic deaths because they're more likely to live near roadways, according to the report. Transportation-related injury remained the third leading cause of death among all unhoused L.A. County residents and the second leading cause among unhoused women.
Traffic-related injuries caused 8% of all unhoused deaths in L.A. County in 2023, and the mortality rate associated with these deaths increased 50% compared with 2019.
County health officials recorded 347 traffic-related unhoused fatalities in 2022 and 2023. They found that the deaths were not concentrated in any specific location but spread out across L.A. County.
In 2023, 14% of all fatal traffic accidents reported to police involved unhoused victims, according to LAPD data.
4. Homicide
Homicide was the fourth leading cause of death among unhoused people in L.A. County in 2023. That year, 120 unhoused people were killed at the hands of another, a 25% decrease in the homicide mortality rate from a year earlier.
Unhoused Angelenos were 16 times more likely to die by homicide than the general population.
5. Suicide
The suicide rate among L.A.’s homeless population has remained relatively stable over time. Unhoused residents are eight times more likely to die by suicide than Angelenos in general.
Suicide rates have been consistently higher among younger people experiencing homelessness and among white and Latino people experiencing homelessness.
Recommendations
The L.A. County Department of Public Health had several recommendations to slow the mortality rate among unhoused people in the region.
They include:
- Ensure rapid access to housing and shelter.
- Expand harm reduction and overdose prevention outreach for residents at highest risk for overdose.
- Ensure that physical health, mental health and substance use treatment services are available and responsive to the needs of unhoused Angelenos.
- Work with municipalities and unincorporated communities to reduce traffic deaths among L.A. County residents experiencing homelessness.
Read the full report here.
