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

ABSTRACT

Objective: To analyze disparities in causes of mortality between unhoused people in King County, Washington and the general population in Washington. Methods: We built a database from the King County Medical Examiner’s list of presumed homeless decedents, 2009–2019, and worked with a homeless advocacy organization to gather detailed cause and mode of death information for each case. Results: The average homeless decedent was 50 years old at death, compared to Washington's life expectancy of 80 years. Homeless homicide and suicide rates were 19 and 5.5 times higher, respectively, than the general population. Overdose death rates were 12 times higher, and pedestrian deaths were 28 times higher among the unhoused. Black and American Indian/Alaska Native decedents were overrepresented in our database in comparison to the general Washington population. Conclusions: The Seattle area suffers significant income inequality, one of the largest homeless populations in the nation, and disproportionately higher death rates among the homeless compared to housed populations. Homeless deaths are fueled by markers of vulnerability and despair – suicide, homicide, and substance use.

KEYWORDS:

• Homeless mortality
• violence
• housing
• social determinants
• homelessness

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 The WA state comparison data combines all deaths labeled “pedestrian,” “cyclist,” “other pedestrian,” “other pedal cyclist.”

2 Defined as “acts of violence against homeless individuals by housed perpetrators” (Leomporra & Hustings, 2018).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Rachel Scott

Rachel Scott, MPH, MSW, conducted this research as a Master of Public Health student at the University of Washington during the 2019-2020 academic year.

Michele Marchand

Michele Marchand is a Community Organizer with SHARE/WHEEL and a Clinical Instructor with the University of Washington School of Public Health.

Bert Stover

Bert Stover, PhD., is a clinical assistant professor in the Department of Health Systems and Population Health.

Kate Causey

Kate Causey, MPH participated in this research as a Master of Public Health student at the University of Washington.

Richard Harruff

Richard Harruff, MD, PhD., has been the chief medical examiner for King County since 2000, specializing in forensic pathology.

Amy Hagopian

Amy Hagopian, MHA, PhD., is a faculty instructor in the University of Washington School of Public Health, Department of Global Health and Department of Health Systems and Population Health.