The Health Research Board (HRB) has published its second report on deaths among people who were homeless at the time of death.1 The report describes deaths that occurred in 2020 and contains updated figures for deaths in 2019.2 The report follows on from research originally commissioned by the Department of Health, which examined deaths in 2019 among people who were homeless.3

Background
The HRB collects data on all deaths among people who were homeless at the time of death in order to better understand and prevent premature death among people who are homeless. The data are extracted from closed coronial files nationwide using the methodology of the National Drug-Related Deaths Index (NDRDI), even if the deaths do not meet the standard NDRDI inclusion criteria.4 The NDRDI validates these data with the Dublin Regional Homeless Executive through its Pathway Accommodation and Support System (PASS).

For this research, deaths are classified as follows:

• Poisoning: a death directly due to the toxic effects of one or more substances (drugs and/or alcohol) on the body, as indicated on the coroner’s certificate.
• Non-poisoning: deaths due to all other causes, either medical or traumatic, irrespective of whether drugs or alcohol were directly implicated in the death.

The deceased were considered as homeless if living in any of the following circumstances at the time of death:

• Homeless – without accommodation (sleeping rough)
• Homeless – temporary or crisis accommodation
• Homeless – severely substandard or highly insecure accommodation
• Homeless – unknown (no further details were available)

These criteria reflect international classifications4,5 that were adapted to reflect the types of accommodation available to people who are homeless in Ireland.

This study examined the number of deaths, cause of death, and characteristics of those who were homeless and died in 2020, where the investigation of the death was complete.

Key findings
The NDRDI recorded 121 deaths among people who were homeless and who died in Ireland in 2020, 69 due to poisoning and 52 due to non-poisoning (see Table 1). Most of these deaths (n=83) were among people who were homeless and in temporary or crisis accommodation; the majority (n=52) of these were poisoning deaths. There were also 23 deaths among people who were sleeping rough.

Over one-half (56%) of those who died were homeless in Dublin. Almost one in two (48%) deaths occurred in temporary or crisis accommodation, while one in three (36%) were in a public place or derelict building and one in 10 (10%) in private dwellings.

Table 1: Total deaths among people who were homeless, by category of homelessness and type of death

* Includes substandard or insecure homelessness, and unknown types of homelessness.
~ Values suppressed due to small numbers.

Characteristics of the deceased

• The deaths were of 95 males and 26 females. One-half of males were aged 42 years or under, while one-half of females were aged no more than 36.5 years.
• Nineteen of the deceased (13 males vs 6 females) had a history of imprisonment.

Substance use history

• Most of the deceased (91%) had a history of substance use, many (45%) with alcohol dependency.
• Heroin (61%), cocaine (56%), and benzodiazepines (36%) were the most common drugs used, and most people who used drugs (88%) used more than one.
• One in four (26%) had ever injected drugs (27% males vs 23% females). Fifteen per cent of males were injecting at the time of death.

Comorbidities

• Hepatitis C was recorded for 16 (13%) deaths, while epilepsy was recorded for 10 (8%).
• Almost one-half (46%) of the deceased had ever accessed substance use treatment.
• One in five (21%) of the deceased were receiving opioid agonist treatment, mainly methadone, at the time of death (17% males vs 35% females).
• Almost one-half (46%) of the deceased had a known history of mental health issues.

Poisoning deaths

• Of the 69 poisoning deaths, 51 were among males and 18 among females.
• The median age at death was 39 years for males and 34.5 years for females.
• The most common drugs implicated in poisoning deaths were opioids, benzodiazepines, and cocaine.
• Alprazolam was implicated in 34 poisoning deaths, while pregabalin was implicated in 16.
• Polysubstance poisoning was a common factor in the deaths of both males (82%) and females (78%).
• One-half (54%) of those whose death involved opioids had previously received substance use treatment and almost two in five (39%) were in treatment when they died.
• A high proportion of deaths involving opioids (69%) occurred in temporary or crisis accommodation, and one in three (33%) of the deceased were with other people at the time of death.

Non-poisoning deaths

• Of the 52 non-poisoning deaths, the majority (n=44, 85%) were of males.
• One-half of those who died were aged 46.5 years or under.
• One in four non-poisoning deaths were due to hanging, and at least one-half (54%) of the deceased had a history of mental health issues.
• Of those who used drugs, the main substances used were heroin, cocaine, cannabis, and benzodiazepines.
• One in four non-poisoning deaths were due to cardiovascular conditions; most were males; and 62% had either alcohol dependency or alcohol implicated in their death.

Deaths among people with no recorded history of substance use

• Eleven (9%) deaths were among people who had no recorded history of drug or alcohol use.
• These were mostly males; one-half had traumatic deaths due to hanging or drowning; and over one-half (55%) had a known history of mental health issues.

Conclusion
The findings of the study can inform policy and measures to prevent premature deaths among people who are homeless in Ireland. The HRB will continue to collect and report these important data.

1    Kelleher C, Keegan E and Lyons S (2024) Deaths among people who were homeless at time of death in Ireland, 2020. HRB StatLink Series 16. Dublin: Health Research Board. Available from: https://www.drugsandalcohol.ie/40328/

2    Annual data are routinely updated when new coronial information becomes available. As such, the 2019 figure for deaths among people who were homeless was revised upwards to 92 deaths.

3    Lynn E, Devin J, Craig S and Lyons S (2023) Deaths among people who were homeless at time of death in Ireland, 2019. HRB StatLink Series 11. Dublin: Health Research Board. Available from: https://www.drugsandalcohol.ie/38793/

4    Busch-Geertsema V, Culhane D and Fitzpatrick S (2016) Developing a global framework for conceptualising and measuring homelessness. Habitat Int, 55: 124–132.

5    Edgar B (2012) The ETHOS definition and classification of homelessness and housing exclusion. Eur J Homelessness, 6(2): 219–225.