Utahns experiencing homelessness died at 10 times the rate of the state’s general population in 2023 and were, on average, 16 years younger at their time of death, the Utah Department of Health and Human Services announced in its first-ever homeless mortality report.
Officials identified at least 216 people who died while experiencing homelessness last year, and found their mean age was 56. More than a third of those deaths were caused by substance misuse, compared to just 5% of the general population. Another third died because of chronic disease, compared to nearly 60% of the general population.
Utah is just the second state in the country to conduct such an analysis, said Tyler Riedesel, the state health agency’s housing-insecure populations epidemiologist. It’s data that Utah’s state homelessness coordinator, Wayne Niederhauser, vowed to eventually provide while speaking at a 2022 vigil that honored people who died while homeless.
The lack of such analyses nationally speaks to the challenges of gathering data on the unsheltered population, Riedesel said, including agreeing on a definition for homelessness and reporting it uniformly.
But making those efforts to quantify the growing homelessness crisis can inform policymakers’ responses, and help health care providers better meet patients needs.
“I think that the challenge now is like, OK, what do we do with it? What changes do we make?” Riedesel said.
The report outlines some options, such as increasing cooperation between homeless service providers and harm reduction groups that run syringe exchanges or give away free drug-testing materials and opioid overdose-reversal drugs.
It also suggested convening an advisory group of health care “funders and providers” to determine how best to reach and care for homeless patients. And the report said more low-barrier health care and substance misuse treatment options are needed.
Riedesel said housing the unhoused is the best way to stop homelessness and save lives — “but health is a big thing” too.
(Christopher Cherrington | The Salt Lake Tribune)
At the 2022 vigil, Niederhauser said the 159 homeless deaths that advocates independently recorded as of that December — higher than any number counted in the previous six years — was likely an undercount because the state had not kept track.
Three months earlier, in September 2022, Utah’s Office of Vital Records and Statistics began their first attempt to count such deaths, adding a field in death reports to indicate whether or not a person was experiencing homelessness when they died. The newly released report only includes data from 2023.
Niederhauser, through a spokesperson, declined to comment on the report until it is discussed during an upcoming Homeless Services Board meeting. The report first appeared on the group’s agenda in August, but it has been pushed to late October as the group continues reviewing municipalities’ required winter response plans.
But Riedesel said even the number outlined in the new state mortality report is likely lower than reality. He also noted the report found that fewer than 11 unsheltered people died from heat or cold exposure, though those numbers don’t reflect whether someone survived frostbite or heat exhaustion.
“I would expect those [injuries] to be much higher numbers than what we have, right?” he said, adding that the low numbers may also indicate progress as more municipalities have begun opening cooling centers, or providing overnight shelters because of the winter response plans initiative.
As death investigators and funeral home employees better understand how to log homeless deaths, Riedesel said he expects the report will reflect the situation more accurately.
“An example of that would be like, does a funeral home think someone who is couch surfing — is that experiencing homelessness or not?,” Riedesel said. “And do they define that in the same way as another funeral home?”
In next year’s report, Riedesel said death investigators and funeral homes will rely on a definition that classifies homelessness as when someone lacks a “fixed, regular, adequate nighttime residence.”
Next steps
Jandia Emerson, CEO of Fourth Street Clinic, said the report showed the clinic’s philosophy for providing health care aligns with the needs of the unsheltered population.
They already run a low-barrier clinic, she said. Patients without health insurance can access care there, and they accept walk-ins. They also offer other services, like dental, mental and behavioral care.
“I think what this [report] tells me is we’re doing a great job of thinking about how we tailor services to meet the specific needs of this population,” she said, “but we need more of it.”
The clinic served approximately 5,900 people in 2023, compared to just under 5,370 in 2022 and around 4,670 the year before, according to its annual reports. Emerson said the clinic is already on pace to see more patients this year than the year prior, as the facility prepares for the busy respiratory virus season.
Emerson said she hopes future reports will dig into chronic diseases — such as breaking down rates of pulmonary disease, diabetes and heart diseases — to see how often they are co-occurring.
She added that she was excited about the prospect of an advisory committee to discuss this population’s health care needs, as well as better integrating harm-reduction services.
Currently, harm-reduction groups often operate outside of other homeless services, said MacKenzie Bray, executive director of the Salt Lake Harm Reduction Project. Some shelters don’t allow individuals in if they have syringes, for instance, she said.
She wants to see more “direct, intentional, purposeful” collaboration.
Bray’s ultimate goal is opening a 24/7 overdose-prevention site — where people can use drugs under the supervision of people trained to spot signs of overdose or other complications.
In the meantime, she said this report and its findings were “thoughtful” and clear about the challenges facing this population, such as how unsheltered people sometimes use drugs to stay awake in order to protect their belongings or themselves, or how others may use them to sleep in crowded or loud environments.
In future reports, Riedesel said analysts hope to expand the scope from people who were homeless at the time of their death to people who were once homeless but had secured housing.
A 2022 editorial in the American Society of Clinical Oncology Journal, for instance, found exposure to the sun; inadequately nutritious meals; living with long-running infections, such as hepatitis C and HIV; and alcohol and cigarette use lead to increased risks of developing cancer.
How might one’s health outcome change once their housing status changes? Riedesel said he wants more first-person perspectives included in future reports.
Once DHHS has collected multiple years of data, it also plans to analyze deaths by county. This year’s report found the highest number of deaths and mortality rates were in Tooele, Utah, Salt Lake, and Weber counties.
Other counties that recorded deaths had numbers so small analysts couldn’t “make reliable conclusions,” the report stated.
