Why did California see a surge in homeless deaths?

Mortality rate attributed to pandemic, overdoses, age

By Thomas Fuller

New York Times

California saw a surge in homeless deaths during the pandemic. But for a number of reasons, that same surge did not happen across the country.

Three times as many homeless people died in Los Angeles County as in New York City during the first year of the pandemic, according to recently released data by public health officials.

A report published Friday by the Los Angeles County Department of Public Health said 1,988 homeless people died in the county from April 2020 through March 2021, a 56% increase from the 12 months before the pandemic began. A separate report published by officials in New York counted 640 deaths among homeless people from July 2020 through June 2021, an increase of just 4% from the previous year.

On paper, New York City has more unhoused people than Los Angeles County. In their most recent published reports, New York officials counted 78,000 homeless people among the city’s population of more than 8 million, compared with 64,000 unhoused people tallied in a count carried out in Los Angeles in 2020, where the county has about 10 million people. (Updated numbers from a count carried out in February are due out this summer.)

But Dr. Margot Kushel, an expert on homelessness at the University of California, San Francisco, said the numbers are misleading. The homeless tallies in California are considered vast undercounts because most unhoused people are unsheltered. The annual counts of the homeless, which often take place on a single night in winter, might capture only a third of the people who are homeless during the course of year, Kushel estimates.

A vast majority of the homeless in New York, by contrast, are in shelters, making it easier for officials to account for them.

And the mortality rates are necessarily different, she said, because the unhoused in New York skew much younger — often families with children — than those in California, where the homeless are more commonly older and single.

“Age is a crucial risk factor for dying,” Kushel said. “What we have seen in homeless populations is elevated deaths rates at all ages, but the highest death rates are among older adults.”

One thing that New York and Los Angeles did have in common was the gender ratio of those who died. It was overwhelmingly male: 81% of homeless deaths in Los Angeles County were of men, compared with 83% in New York.

Half of homeless deaths in New York occurred in hospitals, while the unhoused in Los Angeles were more likely to die on sidewalks, in vacant lots, on park benches and on the beach — a rash of profoundly lonely and yet very public deaths.

Drug overdoses were increasingly intertwined with the homelessness crisis. They were the leading cause of death among the homeless in Los Angeles, where overdoses were responsible for 36% of deaths. In New York, it was 37%. That was a sharp increase from the previous year: Overdoses among the unhoused were up around 80% in both places.

This article originally appeared in The New York Times.

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