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

Abstract

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.