Deaths of homeless people in England and Wales: 2020 registrations

• There were an estimated 688 homeless deaths in England and Wales registered in 2020, a decrease of 11.6% from 2019 (778 estimated deaths); this decrease was not statistically significant and is statistically similar to registrations in the period 2017 to 2019, but represents the first fall in the number of estimated deaths since 2014.

• Figures for 2020 were affected by the Everyone In scheme, which has made it more difficult to identify homeless people in the Office for National Statistics (ONS) mortality records; figures for 2020 may underestimate the true number of homeless deaths.

• Almost two in five deaths of homeless people were related to drug poisoning in 2020 (265 estimated deaths; 38.5% of the total number), consistent with previous years.

• Suicide deaths registered among homeless people fell by around a third since the high seen in 2019 (from 112 in 2019 to 74 in 2020), returning to a level consistent with the period 2013 to 2018 (ranging from 72 to 86 estimated deaths annually).

• There were estimated to have been 13 deaths (1.9% of the total) of homeless people involving coronavirus (COVID-19) registered in 2020.

• Most homeless deaths registered in 2020 were among men (604 estimated deaths; 87.8% of the total), consistent with previous years.

• London and the North West had the highest numbers of deaths registered in 2020, with 143 (20.8% of the total number) and 126 (18.3% of the total number) estimated deaths of homeless people respectively.

The number of homeless deaths fell by 11.6% in 2020

In 2020, there were an estimated 688 deaths of homeless people registered in England and Wales, 90 (11.6%) fewer deaths than in 2019 when there were 778 estimated deaths. The decrease was not statistically significant but represents the first fall in the number of estimated deaths since 2014. Despite the decrease, the latest estimated number of deaths of homeless people is 42.7% higher, and statistically significantly, than the number when our time series began in 2013.

Figures for 2020 were affected by the Everyone In scheme, under which more than 37,000 homeless people have been provided with emergency accommodation since March 2020. Such accommodation included hotels and other locations not typically used to house homeless people, and with no centralised record of these accommodations, this has made it difficult to identify deaths of homeless people housed under this scheme. As such, figures for 2020 may underestimate the true number of homeless deaths.

Changes in the number of homeless deaths over time may be the result of changes in the size of the homeless population. Whilst there is no official estimate of the number of people who are homeless, events and policies enacted in 2020, such as the ban on evictions or the Everyone In scheme, may have resulted in a decrease in the homeless population. It is therefore plausible that the observed fall in the number of homeless deaths is real.

The Department for Levelling Up, Housing and Communities produces an annual snapshot of the number of people rough sleeping (which does not include those in emergency accommodation) in England on a single night in the Autumn. There were 2,688 people estimated to have been sleeping rough in the 2020 snapshot, 37.0% less than the 4,266 reported in 2019, and the third consecutive fall in the estimate. Figures for 2020 for Wales are not yet available.

Deaths of homeless people were identified from the death registration records held by the Office for National Statistics (ONS), and a statistical method called capture-recapture modelling was applied to estimate the most likely number of additional registrations not identified as homeless people.

The figures reported here are the total estimated numbers, except where described as being based on identified records only. The method used provides a robust but conservative estimate, so the real numbers may still be higher.

The estimated number of deaths of homeless people in 2020 is based on 490 identified deaths, a 13.0% decrease from the previous year (563 identified deaths), but similar to the number of deaths registered in 2017 (491 identified deaths).

Figure 1: The estimated number of deaths registered among homeless people decreased in 2020 but remains 42.7% higher than 2013

Deaths of homeless people (identified and estimated deaths), deaths registered between 2013 and 2020, England and Wales

Notes:

1. Estimated numbers show error bars indicating 95% confidence interval of the estimate.
2. Figures are for deaths registered, rather than deaths occurring in each calendar year.
3. Figures for England and Wales may include deaths of non-residents.
4. The total estimated includes the identified deaths plus the additional modelled deaths.

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Figure 2 shows sex and age breakdowns of estimated deaths of homeless people registered in 2020. Males accounted for the larger proportion of deaths: 604 (87.8%) deaths compared with 84 (12.2%) female deaths.

An upper age limit of 74 years was applied to avoid accidental inclusion of elderly people in some institutional settings. See Measuring the data for further information.

Among men, the highest number of estimated deaths were observed in those aged 45 to 49 years (108 deaths; 17.9% of all male deaths), and the mean age at death was 45.9 years.

Among women the 40 to 44 years age group had the highest number of estimated deaths (22 deaths; 26.2% of all female deaths), and the mean age at death for women was 41.6 years.

Mean age at death is not the same as life expectancy. Further information on the mean age at death calculation can be found in Section 15 of the User guide to mortality statistics.

London and the North West of England had the highest numbers of deaths registered in 2020, with 143 (20.8% of the total number) and 126 (18.3% of the total number) estimated deaths of homeless people respectively. The estimated number of deaths in these two regions equated to nearly two-fifths of the total number in England and Wales. Wales (22 deaths) and the North East of England (34 deaths) had the lowest numbers of estimated deaths registered in 2020.

When considering the size of the population, the pattern is similar. The North West of England has the highest rate, with 23.3 homeless deaths per million people. The area with the next highest rate was London with 21.2 deaths per million people. The lowest rates were found in Wales (9.4 deaths per million) and in the South East (10.3 deaths per million).

Since the beginning of our time series in 2013, the crude death rate has more than doubled in three regions (the North West, Yorkshire and The Humber, and the East Midlands).

Figure 4: The death rate has more than doubled in three English regions since 2013

Rates of deaths of homeless people (estimated) by English region and Wales, deaths registered between 2013 and 2020

Notes:

1. Figures are for deaths registered, rather than deaths occurring in the calendar year.
2. Please note that these figures per million are not related to the number of homeless people in an area and are not age-standardised: they should not be compared with published mortality rates.
3. Figures are based the deceased’s place of death and not area of usual residence.

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An estimated 265 deaths of homeless people registered in 2020 were related to drug poisoning accounting for 38.5% of all estimated deaths (see Figure 5). Alcohol-specific causes and suicide accounted for 12.1% (83 deaths) and 10.8% (74 deaths) of estimated deaths of homeless people registered in 2020 respectively.

There were an estimated 13 deaths (1.9%) of homeless people involving coronavirus (COVID-19) registered in 2020, with the majority of these occurring during the first wave. In an earlier analysis, which included deaths where the registered address of the deceased was a hotel, 16 deaths of possible homeless people involving COVID-19 were registered up to 26 June 2020.

Whilst the two methods disagree on a precise number, both indicate that COVID-19 was not a leading cause of death among homeless people. The poor overall health of the homeless population put them at higher risk than people of equivalent age in the general population, with one modelling study suggesting that hundreds of homeless people could have died without the intervention of the Everyone In scheme.

Compared with the previous year, the number of deaths registered caused by drug poisoning fell by 8.3% (from 289 estimated deaths in 2019 to 265 deaths in 2020). Drug poisoning deaths registered in the general population rose by 3.8% over the same time period.

In 2019 the estimated number of suicides registered among homeless people was nearly a third higher than any of the previous 6 years. However, in 2020 the number of suicides returned to a level consistent with the period 2013 to 2018, with an estimated 74 suicides of homeless people registered in 2020.

The number of homeless people dying from alcohol-specific causes has been rising over the past decade. In the first half of our time-series (2013 to 2016) the average annual number of estimated deaths from this cause was 57, by the second half (2017 to 2020) the average had risen to 79 deaths.

In the general population, in 2020, there was a sharp increase of 19.6% in the number of alcohol-specific deaths registered. Among homeless people the increase over the same time period in the number of estimated deaths from this cause was 9.2%.

Finding higher numbers of deaths among homeless people for these causes is consistent with academic studies of the health and mortality of homeless individuals. In comparison, the leading causes of death in the general population for all those aged 20 to 49 years were accidental poisoning (11.1% of deaths) and suicide (11.6% of deaths). In those aged 50 to 64 years, the leading causes of deaths were ischaemic heart diseases (12.5%), COVID-19 (9.5%) and lung cancer (7.3%).

Data on numbers of homeless people who died from other causes can be found in our accompanying dataset.

Deaths of homeless people are often from causes that require an investigation by a coroner, including drug poisoning and suicide. The length of time it takes to hold an inquest results in a delay between the date a death occurred and the date of registration, known as a registration delay. This means that around half of the deaths reported in this bulletin will have occurred in previous years.

For identified homeless deaths registered in 2020, 84.9% were certified by a coroner, and 55.3% actually occurred in 2020. The median delay between the date a death occurred, and the date of registration was 147 days.

It is too early for us to comment on the impact of the coronavirus (COVID-19) pandemic, lockdowns, or the Everyone In scheme, upon the total number of homeless deaths from all causes because of the registration delay described above.

However, for deaths involving COVID-19, which typically do not require investigation by a coroner, the registration delay is shorter. We expect that most of the deaths of homeless people involving COVID-19 in 2020 will have been registered in the same year. Therefore, the figures in Section 4 for deaths involving COVID-19 are likely to be a close reflection of deaths actually occurring during this period.

Homelessness

The definition of homelessness used in this release follows from what is available in death registrations data to identify affected individuals. Our statistics mainly include people sleeping rough or using emergency accommodation such as homeless shelters and direct access hostels, at or around the time of death.

An upper age limit of 74 years is applied to avoid accidental inclusion of elderly people who died in some institutional settings. This means that a small number of genuine deaths of homeless people aged 75 years or over might have been excluded.

Further information on the methods used to identify deaths of homeless people is available in the Deaths of homeless people in England and Wales QMI.

Definitions of homelessness exist for different purposes and there are variations across the UK. This interactive tool allows users to compare different homeless definitions used, and official statistics produced across the four countries of the UK.

Drug poisoning

Deaths classified as a drug poisoning must have an applicable International Classification of Diseases (ICD) code assigned as the underlying cause of death; this is determined by international coding rules from the condition or conditions reported by the certifier, as recorded on the death certificate. For further information on the definition, please see Deaths related to drug poisoning in England and Wales.

Crude death rate

The crude death rate is defined as total deaths per one million people or: (total deaths divided by total population) multiplied by 1,000,000.

Quality

The figures in this release were produced following a two-stage process. First, the complete death registration records held by Office for National Statistics (ONS), for deaths registered in the calendar years 2013 to 2020, were analysed using multiple search strategies to identify all those deaths where there was evidence that the deceased was homeless at or around the time of death. Then, the results of the searches were used in a statistical modelling technique known as capture-recapture to estimate a total figure, which allows for the likelihood of more deaths of homeless people being present in the data but not identified.

Based on the nature of the data and the diagnostic and goodness-of-fit statistics produced by the package, the Chao model was selected out of several alternatives. This is a robust but conservative (lower bound) model, so that the figures produced should be taken as the lowest probable estimates.

More quality and methodology information on strengths, limitations, appropriate uses, and how the data were created is available in the Deaths of homeless people in England and Wales QMI.

Further development of these Experimental Statistics

We are committed to improve this Experimental Statistic with the help of users, including local authorities and charities, academics, and the General Register Office. However, improvement work has been delayed by the impact of coronavirus (COVID-19)-related work priorities.

We will resume this work early next year and really welcome your comments and suggestions by email at health.data@ons.gov.uk.