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Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
Alameda County Homeless Mortality Report
Calendar Year 2023
Executive Summary
A responsible and just community must work to be closely aware of the deaths of all its
members, strive to learn from those deaths and implement policies and practices to
reduce preventable deaths, support equitable and appropriate end-of-life services, and
work to reduce the harm that preventable deaths create for families, friends, caregivers,
and the community. A just community will review places and moments of death to ensure
that people do not die alone and experience death in as peaceful a manner as possible.
The Alameda County Health Care Services Agency’s Health Care for the Homeless
(ACHCH) program and the Public Health Department’s Community Assessment, Planning,
and Evaluation (CAPE) unit carried out Alameda County’s first-ever homeless mortality
report in 2020 for deaths from 2018 to 2020 and do this report on an annual basis.
This report is based on identifying homeless deaths through data matching across County
homeless services utilization lists, community and clinical reporters, and California
Comprehensive Death File (CCDF) records in the California Vital Records Business
Information System.
Because of the methods used, Alameda County’s homeless death numbers will appear
higher than those of other localities that rely solely on medical examiner/coroner’s reports
of homeless deaths.
Key Findings in the 2023 Alameda County Homeless Mortality Report
In calendar year 2023, 342 persons were determined to have died in homelessness in
Alameda County. In addition, there were 300 deaths of persons with a recent experience of
homelessness but were housed at the time of their death, and 101 persons with a recent
history of homelessness but whose housing status at the time of death was not possible to
determine.
Alameda County 2023 Homeless Deaths Count
342
300
but with unknown/undetermined housing status at the time of 101
The number of annual homeless deaths grew considerably between 2018 and 2020 and
continues to remain at a very high level through 2023. Between 2018 and 2023, 1,845
Alameda County residents have died while experiencing homelessness:
Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
Alameda County Homeless Deaths 2018-2023 by Homeless Status
Year
Known to be
homeless at time
years of death, but
housed at time of
years of death, but
unknown housing
Alameda County Number of Homeless Deaths by Region of Last Residence (2018-2023)
Year
Berkeley/
(Hayward,
Alameda, San
Leandro,
Oakland/ South County
(Fremont, Union
Tri-Valley
(Livermore, Dublin,
Total 162 389 1063 157 74
195
246
368
343
351 342
57 91 102 145
266 300
190 198
211
162
95 101
2018 2019 2020 2021 2022 2023
Alameda County Trends in Homeless Deaths, By Housing Status
(2018-2023)
Known to be homeless
at time of death
Homeless within 5
years of death, but
housed at time of death
Homeless within 5
years of death, but
unknown housing
status at death
Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
CY 2023 Homeless Mortality Overview
Median age at time of death of
people experiencing
homelessness:
54 Years
Mortality rate: The age-adjusted mortality rate for people experiencing homelessness in
Alameda County in 2023 was 2,939 homeless deaths per 100,000, or 5.4 times that of the
general population of Alameda County. For many leading causes of death, mortality rates
continue to be many times higher for people experiencing homelessness than the general
population.
Unattended deaths: Seventy-two percent (232) of homeless deaths took place outside of
a medical setting (e.g., hospital or nursing facility), instead occurring outdoors; on streets
or sidewalks; in shelters, encampments, vehicles; other’s residences; and other locations.
Twenty-eight percent of homeless acute/chronic disease-related deaths (38 out of 100)
occurred in these “unattended” settings, a 16% decline from last year.
Disparities by race/ethnicity and gender: African American/Black persons represent 42%
of homeless deaths, compared to 18% of general population deaths and 11% of the
general population. Men represent 76% of homeless deaths, compared to 53% of general
population deaths. The median age at death among people experiencing homelessness is
54 years, compared to 77 years in the general population, a difference of 23 years.
Female
81
23.7%Male
261
76.3%
Alameda County Number
of Homeless Decedents by
Sex (2023)
2 6
43
59
74
90
68
<18 18-24 25-34 35-44 45-54 55-64 65+
Alameda County Number of Homeless Decendents
by age group (2023)
3
3
9
10
11
62
101
143
Pacific Islander
Native American
Multirace
Unknown/Withheld
Asian
Hispanic/Latino
White
African American/Black
Alameda County Number of Homeless Decedents by
race (2023)
Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
Characteristics of Homeless Deaths in 2023
Drug overdose: Thirty-nine
percent of homeless deaths
in 2023 (134) were directly
due to unintentional and
unknown intent drug
overdoses (hereafter called
‘drug overdoses’). The
number of drug overdoses
among people experiencing
homelessness continued to
rise sharply. Eighty percent
of drug overdose deaths
took place in outdoor
settings. People
experiencing homelessness have 47.8 times the drug overdose death rate of the general
population.
• Acute/chronic medical conditions: Forty percent of the homeless deaths in 2023
(138) were due to acute/chronic medical conditions, led by heart and cardiovascular
disease and followed by cancer, cerebrovascular disease diabetes, respiratory
disease, liver disease, COVID-19, and others. Twenty-eight percent of acute/chronic
disease-related deaths were unattended, occurring outside of medical/clinical
settings.
• Accidental injuries (excluding drug overdose) accounted for 21 (6.1%) homeless
deaths, the large majority being pedestrians and cyclists hit by automobiles, followed
by falls and struck by trains. Homeless pedestrians/bicyclists are 35 times more likely
to be killed by cars than the general population.
• Homicide accounted for 23 (6.7%) deaths of people experiencing homelessness,
mostly due to shootings and stabbings taking place in the street and outdoors. The
death rate for homicide among people experiencing homelessness is 16.9 times that of
the general population.
• Suicide: Nine people experiencing homelessness took their own lives in 2023, a rate
9.6 times that of the general population.
• Shelter residents: Forty-eight persons were known to be residing in homeless shelters
at the time of death in 2023. Sixty-five percent of them died of acute/chronic diseases,
25% of drug overdoses, and the remaining by suicide, accident, and homicide. The
percentage of shelter overdoses increased from 17% in 2021 to 25% in 2023.
• Encampments: At least 24 people died in homeless encampments in 2023. Eighty-
three percent of them died of drug overdoses, 13% of acute/chronic diseases, 8% from
homicide, and 4% were due to exposure or an accident.
• Vehicle dwellers: About 18 persons were reported as having died inside their vehicle of
residence in 2023. This is in addition to those who might have died in facilities but lived
35
61
95 106 110
134
2018 2019 2020 2021 2022 2023
Alameda County Trends in Number of Homeless Drug
Overdose Deaths (2018-2023)
Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
in their vehicle. Of them, 66% died of drug overdoses, 22% of acute/chronic disease,
and the remainder by homicide and unknown cause.
• COVID-19: COVID-19 was the cause of death for 2 persons experiencing
homelessness in 2023.
• Hospice-eligible deaths: In a review of the homeless deaths, ACHCH determined that
at least 45 (13.2%) of the homeless deaths appeared to be “hospice-eligible” or
“expected” deaths due to terminal illness. Of these 45 deaths, 16% were unattended.
Of the 38 hospice-eligible deaths that occurred in hospital, more review is needed to
determine if the decedents received appropriate palliative or hospice care services.
Category 2018 2019 2020 2021 2022 2023 2018-
2023
Percent-
age
Acute/chronic
disease 96 114 179 152 154 138 833 45.2%
Drug overdose/
substance
abuse-related
49 76 105 109 122 141 602 32.6%
Accidental injury 21 27 34 31 33 21
Homicide 16 15 28 22 22 23
Suicide 10 9 16 9 10 9
Unknown (R99) 3 5 6 20 10 10
Alameda County Number of Homeless Causes of Death, by Specific Underlying
Causes (2018-2023)
Cause 2018 2019 2020 2021 2022 2023 2018-2023
Overdose Unintentional
or undetermined intent 36 61 97 102 110 134 540 29.3%
All other diseases 17 23 43 35 28 35 181 9.8%
Cancer 15 18 16 16 21 20 106 5.7%
All other injuries 9 11 14 17 21 8 80 4.3%
Chronic liver disease and
cirrhosis 11 13 23 8 10 5 70 3.8%
Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
Suicide 10 9 16 9 10 9 63 3.4%
alcohol abuse & 9 11 7 7 10 7 51 2.8%
unknown cause or 3 5 6 20 10 10 54 2.9%
2 9 10 7 5 6 39 2.1%
Cerebrovascular disease 4 7 11 4 6 7 39 2.1%
1 4 11 3 7 6 32 1.7%
Diabetes mellitus 3 1 7 4 10 5 30 1.6%
struck by train
unintentional/undet.
4 4 4 4 4 3 23 1.2%
disease/essential 1 3 3 6 6 2 21 1.1%
HIV 1 1 3 5 3 1 14 0.8%
Pregnancy; perinatal; 1 1 1 0 3 0.2%
1 1 1 3 0.1%
Total 195 246 368 343 351 342 1,845 100%
Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
Alameda County Age-Adjusted Mortality Rates by Cause of Death, Homeless vs.
General Population (2023)
Cause of Death Homeles
s Deaths
2023
Age-Adjusted
Mortality Rate
Homeless
General
Population
General
Population Age-
Adjusted Rate
vs. General
Mortality
Overdose, unintentional or
undetermined intent
134 1108.4 410 23.2
Heart disease 48 435.4 2109 102.2
All other diseases 34 290.0 1727 84.4
Homicide 23 134.9 136 8.0
Cancer 20 205.2 2175 105.1
R99 (ill-defined, unknown
cause or missing code)
9 91.3 48 2.8
Suicide 9 76.0 143 7.9
Pedestrian or bike crash 9 70.9 55 3.1
All other injuries 8 67.9 264 13.7
Cerebrovascular disease 7 64.3 761 36.5
Sequelae of drug and alcohol abuse & dependence 7 49.1 66 3.4
Chronic lower respiratory
disease (CLRD)
6 62.3 336 16.1
Other communicable diseases 6 60.8 188 9.2
Chronic liver disease and
cirrhosis
5 32.4 142 7.2
Diabetes mellitus 5 34.8 386 18.7
Pedestrian or bicyclist struck by train
48.4
1.1
NA
4.4
0.2
Exposure (heat or cold) 1 9.8 2 0.1
HIV 1 9.8 31 1.6
Alcohol overdose 8 0.5
Pregnancy; perinatal 62 4.1
* A mortality rate ratio of 1.0 indicates equal mortality rates between the homeless and the
general population. A rate ratio greater than 1.0 indicates a higher rate of mortality among
people experiencing homelessness. For example, people experiencing homelessness have
a rate of drug overdose death 47.8 times higher than the general population.
Alameda County Homeless Mortality Report Calendar Year 2023 Executive Summary
FINAL 12/13/2024 https://www.achch.org/alameda-county-homeless-mortality.html
Next Steps
This Alameda County homeless mortality report focuses on data and accurately
enumerates deaths among our unhoused communities. To advance this work, in 2023 the
County of Alameda convened a Homeless Mortality Review Team to further analyze these
data, inform the development of future mortality reports and the coming dashboards, and
make recommendations to reduce preventable deaths among people experiencing
homelessness.
Beginning in early 2025, instead of publishing a detailed annual homeless mortality report
and analysis, Alameda County Health Care for the Homeless (ACHCH) and Community
Assessment, Planning, and Evaluation (CAPE) staff will produce an online, public-facing,
user-driven, and filterable data dashboard for homeless mortality data which will allow
providers and the public to analyze countywide homeless mortality data. For updates, go
to https://www.achch.org/alameda-county-homeless-mortality.html.
Specific homeless mortality data questions or requests can be sent to achch@acgov.org.
Press inquiries should be directed to hcsa-pio@acgov.org.
Acknowledgments
This report was produced by the Alameda County Health Care Services Agency’s Health
Care for the Homeless (ACHCH) program and Community Assessment, Planning, and
Evaluation (CAPE). Matt Beyers and Yilak Fantaye, CAPE, provided epidemiological
direction and guidance. David Modersbach, ACHCH, provided analysis, content, and
writing. Special thanks to Wilma Lozada, ACHCH, for the record review and to Julia
Raifman and Patric Prado from CAPE, and Sarah Garmisa from the HCSA Social Health
Information Exchange.
We depend upon and deeply thank our community of providers and community members
who supported this effort and our collective efforts to reduce mortality, improve health and
end homelessness in Alameda County.
Alameda County Health Care for the Homeless
1404 Franklin Street #200
Oakland CA 94601
510-891-8950
www.achch.org
Alameda County Health Care for the Homeless program is supported by the Health
Resources and Services Administration (HRSA) of the U.S. Department of Health and
Human Services (HHS) as part of an award totaling $4,552,466 and other non-federal
funding sources. The contents are those of the author(s) and do not necessarily represent
the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For
more information, please visit www.HRSA.gov.