Multnomah County's Domicile Unknown report shows 18% decline in homeless deaths from 2023 to 2024. Overdose, transportation, assault are main contributors. by Jeremiah Hayden At least 372 Multnomah County residents died while homele ss in 2024, according to the county’s latest Domicile Unknown report. That’s down 18 percent from the 2023 high of 456. Multnomah County releases its Domicile Unknown report in December each year, compiling demographic data and cause of death for the prior year. The county published the latest Domicile Unknown report December 19, detailing statistics for 2024. The report shows the majority of deaths of unhoused residents were caused by accidental injury, such as drug overdoses, and those who died did so at an average age far younger than the current US life expectancy of 78. “Each person represented in this report had a meaningful story; their deaths were tragic and most were preventable,” the report states. “These community members were people that our outreach teams connected with and clinicians cared for — we were impacted by their lives, and we keep their stories close to our hearts.” The report includes 321 recorded deaths from the Multnomah County Medical Examiner, and 51 from vital records of those who died in hospitals or under other medical care. The Oregon Legislature introduced a bill that went into effect in 2022 requiring housing status to be reported when a person dies. This is the third year those deaths have been included. On average, homeless county residents died at the age of 48. That’s 30 years younger than the life expectancy at birth in the US in 2024. Overall, the mortality rate for homeless residents was six times higher than the general population, adjusted for age.  “The reason for this heightened risk is complex and due to intersecting factors,” the report states. “Multiple causes both lead to homelessness and increase health risks, including lack of affordable housing, racial injustice, lack of social support systems, substance use, mental health challenges, trauma, and a lack of access to physical and behavioral healthcare.” The report comes amid a bleak outlook for homeless support systems nationwide. The latest data from October shows nearly 17,000 people are homeless in Multnomah County, with nearly 7,800 unsheltered. Over 5,000 are reportedly sheltered, but an additional 4,000 are recorded but their shelter status is unknown. With federal cuts to social programs wreaking havoc on local services, local governments have paused rent assistance programs while the city of Portland remains laser-focused on temporary shelter. More people are entering homelessness than local governments can house or shelter each month. In October, nearly 1,970 people became homeless or reengaged with homeless services in Multnomah County—1,382 for the first time—while 1,275 people exited homelessness. Just 409 of those exiting homelessness entered permanent housing, while the remaining 866 became inactive in accessing services. Overdose accounts for vast majority of deaths Accidental injury was the leading cause of death for homeless residents in 2024, and the majority of those were due to drug overdose. At least 214 people—87 percent of unintentional injuries—died due to overdose, with 71 percent involving both an opioid and a stimulant.  Men accounted for the highest number of overdose deaths, at 175, compared with 39 women, while 76 people aged 35-44 died in 2024—accounting for 36 percent of overdoses. Over half of those who died from overdose were between the ages of 35 and 54, according to the report.  Homeless residents were 40 times more likely to die from a drug overdose than the general county population. Demographic data was not equally distributed with regard to race. The report also shows inequities in overdose deaths: 23 people, or 11 percent of those deaths were of Black/African American residents, despite making up 6.4 percent of the general county population, according to the data.  Overdose statistics for 2024 were lower than in 2023. Compared with 214 people this year, the prior year’s report shows that 282 homeless residents died of overdose. That was the highest year on record for overdose deaths, a year in which 456 residents died without a home. The reduction mirrors a trend seen nationwide for homeless or housed individuals. Among all Multnomah County residents, opioid overdose deaths declined from 483 in 2023 to 379 deaths in 2024. Still, the report underscores the need for low-barrier access to effective drug treatment services. The most recent data from Multnomah County shows the new deflection center—which allows a person to complete substance abuse treatment rather than going to jail— saw only 29 percent of people complete treatment after being referred for services. More than 80 percent of those referred for treatment were unhoused. The Domicile Unknown report noted that housing is a crucial aspect of determining health outcomes and is associated with inequities, like mental and physical health challenges, trauma, and can contribute to substance use disorders. “While people with substance use disorders may be more likely to face unstable housing situations, the stress and context of homelessness can also worsen substance use,” the report said. “People experiencing homelessness might also be more likely to use drugs alone and face more barriers to accessing treatment.” Traffic crashes second-leading cause of death for unhoused residents Transportation crashes were the second leading cause of death, killing 19 people, or 8 percent of all unintentional injuries. Homeless residents were 23 times more likely to be killed if they were in a traffic crash than the general Multnomah County population, and 54 times more likely if they were homeless pedestrians or cyclists.  The report noted that nearly all transportation deaths occurred in the darkest hours, before sunrise or after sunset. Just three of the 19 deaths occurred in daylight. In the city of Portland, that aligns with overall trends. Traffic fatalities in Portland occurred during low light 84 percent of the time in 2024. That’s down from 2023, a year in which 22 people died due to traffic incidents. That year, homeless residents were 58 times more likely to die in traffic incidents than the general county population. The trend is also on par with local trends. Portland saw 58 traffic fatalities in 2024, and 43 have been killed as of December 19. Assault accounted for 17 deaths among homeless county residents in 2024, with 13, or 76 percent, due to firearms. That’s an uptick since 2023, when 14 assault deaths were recorded. The increased risk of dying by assault is 24 times higher for homeless residents than for the general population of Multnomah County. Additionally, 13 people took their own lives—an increased risk seven times higher for homeless residents. In 2024, 88 homeless people died in Multnomah County from natural causes. Most were certified by a healthcare provider, at 51, while the remaining 37 were certified by the medical examiner. Cancer (13), heart disease (9), and respiratory disease (9) were the leading natural causes of death.  Overall, the data shows that deaths of homeless residents in 2024 were not equally distributed across racial demographics. The county report shows Black/African American, American Indian/Alaska Native homeless residents were overrepresented in the report. “Structural racism and exclusionary policies that constrain access to housing, education, employment and healthcare infrastructure are likely underlying causes of the inequities in mortality among (people experiencing homelessness) by race,” the report said. The annual Homeless Day of Remembrance to commemorate lives lost in 2025 will be held Sunday, December 21 at St. Andre Bessette Catholic Church in Portland (601 W Burnside). Doors open at 5pm. Lifesaving supplies can be dropped off at the event, or at Ground Score Association, 624 NW Couch. Organizers will accept blankets, socks, hand warmers, tents, tarps, body wipes, small flashlights with batteries, bungee cords, bottled water, and new or lightly used backpacks.   ...read more read less