State report finds high rates of frostbite and hypothermia injuries for Alaska’s unhoused

A new report from Alaska’s Department of Health showed that unhoused people saw significantly higher odds of getting serious cold exposure injuries — frostbite and hypothermia — than people who had housing in recent years, the report found. And the rates of such injuries among unhoused Alaskans steadily increased.

The findings may seem obvious, but the report underscores a persistent threat to those living without housing or shelter during Alaska’s winter months, said Riley Fitting, a state epidemiologist and an author of the report.

“We examined this problem because people without housing are at an elevated risk for health complications in general. And we wanted to write this to look at one acute health complication that has pretty severe, lasting effects,” Fitting said. “You know Alaskans, we’re pretty hardy when it comes to the winter, but if someone’s outside for an extended period of time in sub-freezing temperatures, the chance of cold exposure injury occurring is pretty high, and those cold exposure injuries have pretty severe complications.”

Deep frostbite can result in the amputation of fingers, toes, hands, feet and limbs.

“Losing a foot overnight will drastically impact the rest of that person’s life. And we really wanted to highlight this,” Fitting said.

The state health bulletin examined the number of cold exposure injuries statewide over a 10-year period, 2012 through 2021, using data from the Alaska Trauma Registry, which collects information on injured patients from Alaska’s hospitals and acute care facilities. The registry only has data on cases where a patient was hospitalized or transferred to some higher level of care, or died in the emergency room, Fitting said.

Epidemiologists found that Alaska’s homeless population had 8.3 times the odds of a cold exposure injury compared to people with housing.

The rates of cold injuries among people without housing also steadily rose during the 10-year span. The highest rate occurred in the most recent year in the report, 2021, at about 25 per 100 hospitalizations for injuries.

Overall, the rate was 13.8 cold exposure injuries per 100 hospitalizations for injuries among unhoused people, while people with housing saw a cold injury rate of just 1.6 per 100 hospitalizations during the 10 years of data.

The state report posits that injury rates likely have risen, in part, due to recent harsh winters, with colder-than-average temperatures and higher snowfall in 2020 and 2021. Similarly, 2012 had the third-highest rate of cold injuries among homeless Alaskans, a year in which Anchorage saw record snowfall.

The report doesn’t include injury data for the last winter season, which saw near-record snowfall in Anchorage.

“But outside of those years, in between those years, from 2013 to 2019 we still see that that rate generally increasing,” Fitting said. And there isn’t such an apparent trend for injuries among housed residents, he said.

In nearly a quarter of all hospitalizations from cold exposure, being unhoused was the main contributing factor — a total of 132 out of the 566 frostbite and hypothermia hospitalizations, according to the bulletin. Other principal factors included recreation and subsistence activities, Fitting said.

Dr. Dan Mindlin, an emergency physician at Providence Alaska Medical Center, frequently sees frostbite and trench foot and “almost always in people experiencing homelessness,” he said.

Mindlin added that, in his anecdotal experience, hypothermia is usually more associated with outdoor recreation and unexpected circumstances, like someone becoming injured while out in the backcountry.

David Rittenberg, senior director of adult homeless services with Catholic Social Services, says frostbite is often seen in the organization’s medical clinic and respite care program at Brother Francis Shelter.

“I’m happy that someone is looking at this in a scientific way, that this is being studied, because this is something that we’ve known has been an issue in the population experiencing homelessness for a long time, especially in a subarctic climate like Anchorage,” he said.

That can further entrench a person in homelessness, making it more difficult to perform daily tasks, work and become self-sufficient, he said.

“It’s not the flu, it doesn’t go away. If you get frostbite and you lose your fingers — that affects you for the rest of your life,” Rittenberg said.

The Municipality of Anchorage has been preparing to open about 400 shelter beds in the coming weeks, though city officials have not yet finalized Anchorage’s emergency winter shelter plans. Another about 300 people usually continue living outside through winter, city officials have said.