Multnomah County’s 2022 Domicile Unknown report finds 315 homeless residents died amid surge in overdoses, homicides, self-harm deaths and traffic fatalities
Editor’s note: This story discusses drug overdoses, self-harm and violence.
A record of at least 315 homeless Multnomah County residents died in 2022, according to the county’s Domicile Unknown report released in collaboration with Street Roots advocacy Dec. 20.
Accidental drug overdoses, homicides, people taking their own lives and traffic fatalities were the four leading causes of death for homeless Multnomah County residents, aside from “natural” deaths, according to the report. The county estimates homeless residents were 5.6 times more likely to die than the general county population from any cause in 2022, with an average age at death — 49 years old — nearly 30 years lower than the national life expectancy.
“The majority of these deaths were preventable,” the report found. “In fact, the average age at death was 49 years, which is nearly 30 years lower than the United States average life expectancy in 2022.”
The 2022 report is the first year to incorporate medical facility records, or “vital statistics,” provided by the Oregon Health Authority, while it previously relied entirely on Multnomah County Medical Examiner reports since its inception in 2011. Medical examiner reports alone captured 249 deaths in 2022, marking a 29% increase over the previous highest death total — 193 in 2021. Vital statistics captured another 66 deaths, all listed as “natural.”
Accidental drug overdoses were the most common cause of death, with 123 deaths. Aside from the 121 deaths classified as “natural,” homicides were the second-leading cause of death, with 25 homeless Multnomah County residents killed in homicides in 2022, a 38% increase from 2021. Sixteen homeless Multnomah County residents took their own lives in 2022, double the number of people who took their own lives in 2021. Another 14 homeless Multnomah County residents died as a result of traffic incidents.
Homicides Homeless people are much more likely to be victimized by violent crimes nationally, as Street Roots reported July 2022 . That dynamic exists locally, as the county estimates homeless Multnomah County residents are 32 times — or 3,200% — more likely to be killed in a homicide than the general county population.
A Street Roots analysis did not find any 2022 Multnomah County homicides of a homeless resident outside of Portland, meaning up to 26.5% of the 94 Portland homicide victims in 2022 may have been homeless Portlanders despite making up less than 3% of the total population . A Street Roots analysis found homeless Multnomah County residents were 20% of all county homicide victims in 2021.
Homicides of homeless county residents increased in the last four years and exploded in the last two years, going from six homicides of homeless residents in 2019 to eight in 2020 to 18 in 2021 and to 25 in 2022 — a more than 300% increase in that time.
Gun violence directed at homeless Multnomah County residents also increased significantly since 2019, when three homeless residents were killed by firearms. The number doubled to six in 2020, then more than doubled in 2021, with 13 homeless residents killed with firearms. It went up again in 2022 when 16 homeless residents were killed with firearms.
Overdoses Overdoses continued to be a prominent cause of death for homeless Multnomah County residents in 2022. Of the 315 recorded deaths in 2022, 123 — 39% — were caused by drug overdoses, the county found.
Methamphetamine was an underlying cause of death, including in some cases involving multiple substances, in 81% of all overdoses, according to the county. Fentanyl was involved in 74% of all overdose deaths. The involvement of meth in overdose deaths decreased by 1% from 2021, while the prevalence of fentanyl-related deaths more than doubled from the 32% in 2021.
Fentanyl-related deaths continue to rise sharply among homeless county residents, after fentanyl was involved in 3% and 5% of overdoses, at most, in 2019 and 2020.
Deaths involving both meth and fentanyl also occurred at a high rate in 2022, with the county classifying 78 overdose deaths — 63% of all overdoses — as involving both “opioid + psychostimulant.” There were 47 overdose deaths involving both an opioid and any amphetamine in 2021, accounting for 42% of all overdose deaths that year.
Overall, the county estimates homeless residents were 37 times more likely than the general county population to die from an overdose in 2022.
People taking their own lives Instances of homeless county residents taking their own lives also increased again in 2022.
In 2022, 17 homeless county residents took their own lives, more than doubling the number of eight in 2021 and more than quadrupling the four people who took their own lives in 2020.
Much like other prominent causes of death listed in the report, the county estimates homeless residents were 18 times more likely than the general county population to take their own lives in 2022. People taking their own lives accounted for nearly 7% of the 249 homeless resident death certificates signed by the medical examiner.
Traffic fatalities Homeless county residents dying in traffic crashes came under more scrutiny in the 2022 report, with 14 homeless residents dying in traffic fatalities. Traffic-related fatalities were the second-leading cause of accidental deaths after overdoses.
“People experiencing homelessness have high exposure to traffic related injuries and deaths due to high exposure both from living in near-road environments and from consistent exposure resulting from being outside the majority of their days and nights,” the report found. “The deaths accounted for 10% of the total unintentional injury deaths among (persons experiencing homelessness).”
The county estimates the risk of homeless residents dying in traffic crashes was “nearly 45 times that of the general Multnomah County population.” While the 2021 report doesn’t specifically discuss traffic-related deaths, a county analysis of 2020-2021 traffic deaths found 25% of decedents “were likely experiencing homelessness at the time of death,” according to the report.
Racial disparities Black and Native American/Alaska Native county residents are overrepresented in the homeless population and continue to be overrepresented in deaths among homeless county residents, though the county’s racial demographic data is shaky, with the race of 38 decedents listed as “missing/unknown/other.”
While the demographic data in the report isn’t a 1:1 comparison with U.S. Census data due to different practices in amassing those data sets, racial disparities are clear.
Black homeless county residents accounted for over 10% of all homeless deaths in which the county lists a race for the decedent, despite making up just over 6% of the population, according to the U.S. Census Bureau.
Native American/Alaska Native homeless county residents accounted for over 5% of all homeless deaths in which the county lists a race for the decedent, despite making up less than 2% of the county population, according to the U.S. Census Bureau.
White homeless county residents accounted for 73% of all homeless deaths in which the county lists a race for the decedent, and make up 78% of the county population, according to the U.S. Census Bureau.
Dying young While the 2022 Domicile Unknown average life expectancy increased to 49 from 47 in 2021, the numbers can’t be directly compared due to the 2022 inclusion of “vital statistics,” which are deaths certified by a health care provider rather than the county medical examiner. The improvement in life expectancy, if it exists at all, is less than the modest two years found in comparing the 2021 and 2022 reports.
The average age of death for the 66 homeless county residents whose deaths were certified by a health care provider was 58 years old, substantially higher than the overall life expectancy in the report of 49 years old. Previous reports did not include deaths certified by health care providers. The county did not provide an age breakdown divided by data source in the report, so it’s impossible to determine directly comparable life expectancies.
Regardless, homeless county residents had a life expectancy of nearly 30 years less than the national average of 78, according to the county. Homeless county residents under the age of 50 accounted for 48% of all deaths. The largest death count for a single age group was homeless residents aged 50-59, with 81 people dying — 26% of all deaths.
The county found homeless residents were three times more likely to die from both COVID-19 and heart disease than the general county population in 2022.
Locations The most common single place for homeless county residents to die was outdoors, with 113, but 143 total deaths — 45% — occurred outside a residential, medical, shelter or carceral setting. In any health care setting, including inpatient, outpatient or emergency rooms, 119 homeless county residents — 38% — died.
Hotels, correctional facilities and shelters accounted for 23 — 7% — of all death locations.
The highest concentration of deaths by ZIP code, only available for medical examiner-certified deaths, occurred in the Old Town/Pearl District area, followed by Parkrose, inner southeast and Goose Hollow, according to the county.
“As seen in prior reports, deaths have a larger concentration in the downtown Portland Core, North/Northeast Portland, and near the other east-west and north-south arterials of Interstates 84 and 205,” the report found.
Even without ‘vital statistics’ Even excluding the new data source in the 2022 report — 66 deaths certified by health care providers — the data paints a grim, worsening picture of life on the streets in Multnomah County.
The 2022 report found 249 deaths certified by the medical examiner, compared to 193 in 2021 — a 29% increase in one year. Medical examiner-certified deaths increased by 120% since 2019, when the report found 113 medical examiner-certified deaths.
Editor's note: Street Roots advocacy collaborates with Multnomah County to compile and publish Domicile Unknown. The Street Roots newspaper maintains editorial independence from Street Roots advocacy and was not involved in generating the report. The newspaper shared a transcript of an interview with a decedent's family member with the county with consent from the interviewee.
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