Using Point-in-Time Homeless Counts to Monitor Mortality Trends Among People Experiencing Homelessness in Los Angeles County, California, 2015‒2019
Level 4 - case-series / case-control
Population-level surveillance linking coroner/vital records with cross-sectional point-in-time counts
OpenAlex W4200250547 · doi:10.2105/ajph.2021.306502
What was done
Researchers evaluated mortality trends, causes of death, and mortality rate ratios (MRRs) among people experiencing homelessness (PEH) in Los Angeles County from 2015 to 2019. Deaths were enumerated using medical examiner–coroner data linked to death certificates. Denominators were calculated by averaging consecutive annual January point-in-time homeless counts, with annual demographic survey data used to compute age- and gender-adjusted MRRs relative to the general population. Results were compared with findings from existing longitudinal cohort studies identified via literature review.
What was found
Mortality rates among PEH increased from 2015 to 2019, with drug overdose representing the leading cause of death. Mortality rates were higher among White PEH than among Black or Latino PEH. Compared with the general population, the MRR was 2.8 (95% CI = 2.7, 3.0) for all-cause mortality and 35.1 (95% CI = 31.9, 38.4) for drug overdose mortality. Crude mortality rates and all-cause MRRs were similar to estimates from prior longitudinal cohorts.
Why it matters
The study shows that annual point-in-time counts combined with coroner records provide a viable method for urban jurisdictions to monitor health disparities and mortality trends among unhoused populations.
Limits
Exact counts of deaths and underlying cohort sizes are not provided in the abstract. Point-in-time counts provide rough population estimates and can suffer from undercounting or temporal fluctuation. Findings rely on the consistency and accuracy of coroner investigations and death certificate data for identifying unhoused status and cause of death.
Cited by
- supports There are approximately 70,000 homeless people in Los Angeles.