The count of people experiencing homelessness (PEH) in the US hit a record high in 2024. Homelessness, besides its inherent harms, is associated with other injury and broader public health outcomes. As a structural driver of health, these ongoing, dynamic relationships between homelessness and health outcomes deserve robust, ongoing tracking. Holistic tracking of health outcomes requires a multi-pronged approach, including gathering lessons from multiple data sources.
Three multi-year data projects around homelessness have been maturing in North Carolina, led by the NC Division of Public Health, the CDC-affiliated UNC Injury Prevention Research Center, and the NC Coalition to End Homelessness. The first focuses on mortality alone: an improved linkage of Homelessness Management Information System (HMIS) client records to NC Vital Records Death Certificates (DC), chain linking to additional details in our state’s Violent Death Reporting System (NC-VDRS) and State Unintentional Drug Overdose Reporting System (NC-SUDORS) for select causes of death. The second focuses on morbidity: combining literature and lived experience knowledge to design and use a case definition for counting and describing emergency department usage by PEH. The third binds together these two data projects by a pilot linkage of historical emergency department (ED) visit records to death records, focusing on overdoses and other injury events.
Early results in mortality linkage show multiple injury death rates are disproportionately high among PEH. The carefully designed and tested ED visit definition found ED visits in NC by PEH continue to increase, rising to over 1 in 200 ED visits (0.55%; over 26,000 visits) in 2024, including respiratory, alcohol, EMS transport, gastrointestinal distress, and disaster-related visits. COVID-19, disaster-specific trends, and population-specific injury mechanisms and demographic characteristics were also visible across data pipelines.
Students will use some or all of these datasets to perform data analyses, guide literature review, writing, and brainstorming future data projects to help NC public health better track health outcomes in this important and marginalized populations.
Project Leads: Mike Fliss, Mary Beth Cox