2018 ANNUAL SUMMARY OF DEATHS AMONG INDIVIDUALS
PRESUMED TO BE HOMELESS AND INVESTIGATED
BY THE KING COUNTY MEDICAL EXAMINER’s OFFICE
SUMMARY
1. In 2018, the King County Medical Examiner’s Office (KCMEO) investigated the deaths
of 194 individuals presumed to be homeless. This represents 25 more deaths than
investigated in 2017 (n=169).
2. There is little year-to-year variation in the causes of death. Thirty-eight percent (38%)
of presumed homeless deaths investigated by KCMEO were attributed to natural causes,
including cardiovascular and respiratory complications. Thirty-two percent (32%) of deaths
were classified as unintentional injuries from drug overdose.
3. The geographic distribution of presumed homeless deaths investigated by KCMEO
has remained relatively stable over time, with all regions experiencing similar proportional
increases in the number of MEO-investigated deaths among this population.
4. As in recent past years, over half of MEO-investigated deaths occurred outdoors.
A subset of outdoor deaths (n=17) were attributed to a pedestrian-vehicle accident.
The remaining outdoor deaths were attributed to other causes and occurred in spaces
not intended for human habitation.
5. Demographic characteristics of MEO-investigated decedents presumed to be homeless in
2018 is similar to that reported in earlier years. The majority of decedents are male (82%).
African American and Native Americans are overrepresented.

METHODS
The King County Medical Examiner’s Office (KCMEO) investigates deaths that are unexpected,
sudden, violent, suspicious, and/or lack a known cause (approximately 17% of all deaths in King
County). This report describes 194 deaths of individuals presumed to be homeless in 2018. All of
the deaths described underwent autopsy and toxicology testing. Demographics were determined
post-mortem.
The KCMEO determines homeless status based on information inferred from place and
circumstances of death and/or testimony from witnesses or next of kin. Given the complex nature
of human remains investigations and the intricacies of homelessness, use of the term ‘presumed’
is recommended.
The KCMEO definition of “presumed homeless persons” is individuals without evidence of
permanent housing who lived on the streets or stayed in a shelter, vehicle, or abandoned building
at the time immediately preceding death. Decedents who were living in supportive housing,
transitional housing, or a doubled-up situation would not likely be classified as “homeless” by the
KCMEO.

LIMITATIONS
This report does not include all deaths among individuals experiencing homelessness.
Findings are not generalizable to the broader population of persons experiencing homelessness.
Please see the King County Medical Examiner's Annual Report for a full description of KCMEO data.

May 2019

 Trends in the Number and Causes of MEO-Investigated Deaths that Occurred
among Persons Presumed Homeless
There is little year-to-year variation in the
primary causes of death. In 2018, thirtyeight percent (38%) of presumed
homeless deaths investigated by KCMEO
were attributed to natural causes,
including cardiovascular and respiratory
complications. Thirty-two percent (n=63)
of MEO-cases were classified as
unintentional injuries due to drug
overdose.
Seventeen deaths (9% of all investigated
presumed homeless deaths) resulted from
being struck by a vehicle or train or falling
from a bicycle. Hypothermia was a
primary cause of death in <3% of cases
(n=5). Of presumed homeless deaths
investigated by KCMEO, 5% were
attributed to homicide and 7% were
attributed to suicide.
These relative proportions have remained
stable across years.
www.kingcounty.gov/depts/health/examiner/
annual-report/homeless.aspx

Cause Attributed to MEO-Investigated Deaths that Occurred in 2018
among Persons Presumed Homeless
(Abbreviations: “Hypoth”= Hypothermia, “CNS”=Central Nervous System, “Endo”=Endocrine, “GI”=Gastrointestinal; “Hep”=Hepatic Disease)

8

Undetermined

10

Homicide

14

Suicide
Accident

Pedestrian Accident

Hypoth

Other

26
63

Drug Overdose
Natural

Cardiovascular

0

10

Respiratory

20

30

CNS

Cancer

40

# of Deaths

Endo

50

GI Hep

73

Other

60

70

2

 Characteristics of Persons Presumed Homeless and Investigated by the KCMEO in 2018
Year: 2018
Overall
Age
<18
18-34
35-54
55-74
75 and over
Sex
Male
Female
Race
White, non-Hispanic
Black, non-Hispanic
American Indian/AK
Native, non-Hispanic
Asian, non-Hispanic
Other
Unknown
Hispanic
Incident Location
Seattle
South King Co.
East King Co.
North King Co.
Outside King Co.
Unknown

The demographic characteristics of homeless
decedents remained stable over time
(www.kingcounty.gov/depts/health/examiner/
annual-report/homeless.aspx). Presumed
homeless decedents investigated by the MEO
were younger and disproportionately comprised
of men and racial/ethnic minorities. Whereas
the median age of all KC residents who died
in 2018 was 79, the median age of presumed
homeless decedents was 54.

#
194

%
100%

2
34
68
85
5

1%
18%
35%
44%
3%

159
35

82%
18%

145
28

75%
14%

7

4%

4
5
1
4

2%
3%
1%
2%

Similar to previous years, the majority (63%)
of deaths occurred in Seattle, and an additional
21% occurred in South King County.

122
40
9
2
7
14

63%
21%
5%
1%
4%
7%

Over half (n=107) of presumed homeless
deaths investigated by the KCMEO occurred
outdoors. A subset of these outdoors deaths
(n=17) were attributed to a pedestrian-vehicle,
pedestrian-train, or bicycle accidents. The
remaining outdoor deaths were attributed to
other causes and occurred in spaces not
intended for human habitation.

Compared to all KC residents who died in 2018,
a larger proportion of homeless decedents
investigated by KCMEO were non-Hispanic
Black (14.4% vs. 6.3%), non-Hispanic American
Indian/Alaskan Native (3.6% vs. 1.4%), and
male (82% vs. 51%).

2018 Incident Location Categories

Outdoors 55% (n=107)
Parks or Wooded Area (n=61)
Outdoor Urban Locations (n=35)
(includes 17 pedestrian- or bicycle-involved accidents)

Encampments/Abandoned Sites (11)
Motor Vehicles 6% (n=11)
For further discussion of this report,
please see the Public Health Insider blog:
publichealthinsider.com/2019/05/09/
recognizing-deaths-among-peopleexperiencing-homelessness/

Indoors 39% (n=76)
Healthcare Facilities (n=31)
Residences (n=26)
Shelters/Social Services (n=12)
Hotels/Motels (n=7)
3