For the second year in a row, a record number of people experiencing homelessness died in the seven-county Denver metro area in 2018, according to a statewide advocacy group.

The Colorado Coalition for the Homeless worked with local service providers and the Denver medical examiner to count 233 people who died while experiencing homelessness in the metro area between Jan. 1 and Dec. 13. The youngest person who died was 18 years old and the oldest was 73, according to the coalition’s report.

Last year, the coalition found that 231 homeless people had died in the area, a sharp spike from the year before.

“These lives ended on the streets, under bridges, in cars, hospital beds, emergency rooms and shelters, and sometimes in nursing homes or transitional housing,” the 2018 report states.

The Denver Medical Examiner confirmed 110 deaths of homeless people between November 2017 and October 2018. The remaining 113 deaths were tallied by 13 organizations that serve people experiencing homelessness.

Twenty-seven people died of overdoses and 23 died of traumatic injuries, including shootings and suicide. Eight people died of hypothermia.

Denver police investigated several homicides of homeless people over the last year, including the murder of three people camping near Interstate 25 in August. A homeless man was shot and killed in November near the Samaritan House shelter and the Denver Rescue Mission in downtown Denver. The next day, a person fired into a group of homeless people standing three blocks southeast of Coors Field, killing one person and injuring three others.

The medical examiner could not confirm the cause of death in 19 cases.

Many of the drug overdose deaths involved the use of opioids, according to the report. The coalition called for better access to addiction recovery services for people with either no or little income.

An annual survey conducted in January found at least 5,317 people experiencing homelessness in Denver on that day, up 201 from the year before.