At least 815 homeless New Yorkers died in public spaces, shelters and hospitals during the 2022 fiscal year, the most on record, according to city data published on Wednesday.

The death toll among New York City’s homeless population has spiked in the years since the beginning of the COVID-19 pandemic, mostly as a result of drug overdoses.

Drug overdoses accounted for about half the deaths recorded by the two agencies during the last fiscal year, up from about 39% of deaths the previous year, the report found. The rise reflects the lethal impact of fentanyl-laced opioids and other substances in New York and nationwide.

An annual report released by the city’s health and social services agencies highlights the devastating health impacts of housing instability. Heart disease accounted for the second leading cause of death.

“Due to the transience and stressors of housing instability, New Yorkers experiencing homelessness are at a greater likelihood of having pre-existing health and mental health conditions when compared to the general public, which often results in poor health outcomes for this population,” the report’s executive summary states.

The data shows 51 more homeless New Yorkers died last year than in fiscal year 2021, when the previous record high was set. The most recent death toll is four times higher than the number recorded in 2012, past reports show.

Harlem resident Sterling Cash, who spent seven months in homeless shelters last year, said deaths among the homeless are “absolutely preventable,” whether from drug overdose or chronic illness.

“People go down the wrong path and, the next you know, they’re dead,” Cash said. “People need housing. People need to feel like it’s not a hopeless dead end.”

At least 78 people died outdoors, including 19 people killed by “excessive” cold, as New York City struggles to move people from the streets and subways and into permanent housing. Another 155 people died in city shelters, where the population has swelled over the past year. The rest died in hospitals or unspecified locations, the report found.

“There’s no resources to address these problems before there’s death,” said Renee Mitchell, who experienced homelessness and now leads the advocacy organization Breaking the Cycle Drop Corp. “A lot of these would be able to be prevented with [care for] mental health, substance abuse and health.”

City agencies reported 10 confirmed deaths and three probable deaths due to COVID-19 among homeless New Yorkers. Five infants died while living in city homeless shelters. Since 2005, at least 136 infants have died while homeless.

Another 15 New Yorkers were murdered last year, including a man shot to death while sleeping in a Lower Manhattan doorway, down from 22 the previous year.

Homeless New Yorkers and their advocates predicted the grim rise in deaths at an annual memorial observance last December, reported by City Limits.

“The last few years I think we’ve lost more people than I’ve ever experienced in my career,” said Lisa Lombardi, deputy executive director of Urban Pathways. “Every day you’re saying, ‘What’s next?’ And you’re also asking…’What did we do wrong?’ We didn’t do anything wrong [but] you feel so responsible.”

George Nashak, the CEO of the organization Care for the Homeless, pinned the deaths on policies that deny low-income New Yorkers housing and consistent medical care.

“In this, the richest society on Earth, we tolerate devastating health disparities based on the color of a person’s skin with the amount of money they have in their bank account,” Nashak said. “We should be clear that these outcomes are the result of public policy choices we make in the United States.”

The report was released a day after Department of Social Services Commissioner Gary Jenkins announced he was resigning and comes as homelessness is surging citywide.

DSS and the Health Department have not yet provided a response for this story.

Additional reporting by Chau Lam.

This story has been updated with additional information.