An article published by the JAMA Network, “Mortality Among People Experiencing Homelessness in San Francisco During the COVID-19 Pandemic,” examines factors associated with mortality among people experiencing homelessness in San Francisco during the pandemic’s first year. The research compares the characteristics of these deaths to the characteristics of deaths during the previous four calendar years. The researchers found there were 331 deaths among people experiencing homelessness during the first year of the pandemic, which was more than double the number of any previous year studied. Those who died during the pandemic were also less likely to have accessed health services during the pandemic’s first year compared to previous years.
The researchers linked records on details of deaths from the city’s Office of the Chief Medical Examiner (OCME) with data from the San Francisco Department of Public Health (SFDPH) Coordinated Care Management System (CCMS), including demographic data and data about homelessness history, use of various medical services, and shelter history. Homelessness death estimates were calculated beginning March 17, 2020, for a 12-month period. These estimates were compared to annual estimates for 2016-2019. To account for relative changes in the homeless population, the study expresses estimates as rates per 100,000 based on semiannual point-in-time counts.
The research finds that during the first year of the pandemic, 331 deaths among individuals experiencing homelessness occurred, more than double the annual rate of the four preceding years. The majority of decedents were males ages 40 to 60, a group demographically similar to the general population of people experiencing homelessness in San Francisco. Despite the large uptick in deaths, COVID-19 was not cited as the primary cause of death in any of the cases. Drug overdose was the most common cause of death in each of the study years, though it reached a high of 82% during the first year of the pandemic. Fentanyl-involved deaths increased in particular, growing from 52% in 2019 to 68% after the start of the pandemic. Traumatic injuries were the second most common cause of death, including those associated with homicide and suicide.
The research also reveals that many of the deceased accessed fewer support services during the first year of the pandemic compared to years prior. Twenty percent of those who died were connected to substance-use-disorder services in 2019, compared to 13% during the first year of the pandemic. Thirty percent of decedents were connected to mental health services in 2019, which decreased to 24% in the first year of the pandemic. And 76% of decedents used outpatient or acute care services in 2019, compared to 64% in the first pandemic year.
The results of this study differ from those found in other cities, such as New York, where COVID-19 was the second most common cause of death among individuals experiencing homelessness during fiscal year 2020. The results in San Francisco may point to a strong local COVID-19 prevention response but decreased access to other health services. Although COVID-19 was not listed as the primary cause of any deaths studied, the pandemic had far-reaching effects on outreach, health, and social services that may have increased mortality for the homeless population in San Francisco. This disruption of services overlapped with the growing presence of fentanyl in the studied area. Furthermore, the overload on health care providers during the pandemic may have led to decreased opportunities for treatment.
The article can be found at: https://bit.ly/3uubxvY