More and more people – many of them older and without shelter – are freezing to death in winter.
Hypothermia due to exposure to cold temperatures was the underlying or contributing cause of death for 166 Californians last year, more than double the number a decade ago, according to preliminary death certificate data from the U.S. Centers for Disease Control and Prevention. The age-adjusted rate of 3.7 deaths per million residents in 2023 was the highest in the state in at least 25 years.
Hypothermia deaths have also increased nationwide: About 2,520 Americans died last year, an increase of about 35% from 2014, preliminary CDC data shows. In 2022, it was even worse: 3,500 deaths from hypothermia, many of them during brutal winter storms across much of the country in January and December.
The rise in hypothermia deaths is linked to a rise in homelessness, particularly in California, which has the nation's largest unsheltered population, experts say.
Unhoused people are particularly vulnerable to hypothermia because so many older, vulnerable adults live outside where they are exposed to the elements. Government officials have largely responded to the hypothermia deaths by opening warming centers where homeless people can stay on cold nights. But advocates say more permanent housing and more programs to prevent homelessness are needed.
Leon Winch sat on a park bench near the state Capitol and said he was struggling to stay warm as winter approaches. On cold, rainy nights, he tries to find places to stay dry, but private security guards often patrol covered areas, driving him away. Hypothermia often occurs in cold temperatures below 40 degrees, but can also occur in warmer temperatures, especially during rain.
City officials open centers under certain conditions, including when nighttime temperatures are expected to fall below 37 degrees on two or more days in a five-day period. But Winch said he doesn't trust the city of Sacramento and doesn't use the city's warming centers even when temperatures turn freezing.
“They’re not doing anything but window dressing,” he said.
According to the California Department of Health Care Access and Information, from 2019 to 2023, 18% of hypothermia-related hospitalizations and emergency room visits were for unhoused people. Homeless Californians make up nearly 0.5% of the state's population, suggesting their share is about 40 times higher. It's likely that others will end up in the hospital due to hypothermia.
Federal data shows that more than two-thirds of the state's 181,000 homeless people are unsheltered. And among the people who die from hypothermia, one group is particularly hard hit.
Older adults are most vulnerable to hypothermia, with people ages 55 and older accounting for more than three-quarters of hypothermia deaths in California from 2021 to 2023, according to CDC data.
“There is a massive increase in the aging homeless population,” said Margot Kushel, director of the University of California-San Francisco Benioff Homelessness and Housing Initiative. She said the share of single homeless adult Californians age 50 or older has increased from 11% in 1990 to nearly 50%.
And as the number of cold exposure deaths has increased in the state, the number of summer heat exposure deaths has also increased. “A changing climate, more temperature extremes, more rainfall – people are getting older and so they can't even tolerate it, so they're getting a lot sicker and faster,” Kushel said.
The trend could get worse: The share of the homeless population age 65 or older in the United States is expected to triple between 2017 and 2030, according to UCSF researchers.
California's hypothermia mortality rate is highest in rural, mountainous, and northern counties, but most deaths occur in urban centers.
Hypothermia was the underlying or contributing cause of death for 46 Los Angeles County residents from 2021 to 2023 – the highest number in the state. However, due to the county's large population, the mortality rate was below the national average.
Santa Clara, San Francisco and Sacramento had the highest hypothermia death rates among the state's most populous counties. According to CDC data, hypothermia was the underlying or contributing cause of 42 deaths in Santa Clara County from 2021 to 2023, up from 11 in the previous three years.
“Every year we do worse than we did last year,” said Shaunn Cartwright, a homeless advocate in Santa Clara County.
Cartwright said local officials are not providing enough permanent shelters for homeless people, let alone enough temporary shelters on cold nights. It's a problem that Kushel says is widespread across the state.
Michelle Jorden, Santa Clara County's chief medical examiner, said in an emailed statement that she was not sure why hypothermia deaths were increasing but was monitoring the trend. She said the county has sent outreach teams to camps with supplies, set up warming centers and issued cold weather safety alerts during extreme conditions.
In Sacramento County, there were 34 hypothermia-related deaths from 2021 to 2023, compared to 20 hypothermia deaths in 2018 to 2020. Like many other places, Sacramento has enforced homeless ordinances and conducted searches following a Supreme Court ruling USA had given cities more power to impose fines and remove homeless people from the streets. Nearly half of homeless, unsheltered Californians say officials have confiscated their belongings at some point, Kushel said.
Bob Erlenbusch, an attorney with the Sacramento Regional Coalition To End Homelessness, said many homeless people are left cold because local authorities confiscated items such as blankets, sleeping bags and tents during the search.
“You can’t take people’s things,” he said. “They’re supposed to label it and keep it, but that’s not happening.”
Sacramento city spokeswoman Jennifer Singer said city workers would reach out to unoccupied residents before clearing the encampments “so they can manage their belongings before cleanup begins.”
Kushel said the long-term solution to the rise in hypothermia deaths is to prevent people from falling into homelessness and to place those already experiencing homelessness in housing. In the meantime, she said, cities need to open more warming centers — and cooling centers in the summer — and ensure they are accessible.
This article was created by KFF Health Newsthat published California Health Linean editorially independent service California Health Foundation. KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – the independent source for health policy research, surveys and journalism. This story also continued San Francisco Chronicle. It may be republished for free.
