Causes of Death Among the Undomiciled.

Homelessness remains a critical public health challenge that significantly increases the risk of premature mortality. Data from the Washington, D.C. Office of the Chief Medical Examiner were used to examine the mortality rates among undomiciled individuals between 2019 and 2023. This study focused on understanding how factors such as location, submanner of death, and decedent history contribute to overall mortality risk. Our analysis reveals that the Washington, D.C. mortality trends are consistent with observations in larger metropolitan areas and counties. The year 2020 emerged as the period with the highest mortality rate, and the rates demonstrated considerable fluctuations over the study period. In total, 712 deaths were recorded, predominantly among males and African Americans, with an average age of 49.4 years. Notably, intoxication-related fatalities accounted for 57.7% of deaths, with fentanyl being the most common contributing substance. In addition, a significant proportion of decedents had chronic health conditions or a history of substance use, underscoring complex underlying vulnerabilities. These findings highlight the necessity for enhanced mortality surveillance utilizing data from medical examiners and coroner offices to inform and refine public health initiatives and social programs aimed at mitigating preventable deaths among the undomiciled population.